Alteration (customization) to the test data was necessary and is described in Appendix [insert appendix letter ] No alteration (customization) to the test data was necessary
Test ToolCypressePrescribing Validation ToolHL7 CDA Cancer Registry Reporting Validation ToolHL7 v2 Electronic Laboratory Reporting (ELR) Validation ToolHL7 v2 Immunization Information System (IIS) Reporting Valdiation Tool
Edge Testing Tool
(a)(13)
§170.207(a)(3)IHTSDO SNOMED CT® International Release July 2012 and US Extension to SNOMED CT® March 2012 Release
§170.207(j)HL7 Version 3 Standard: Clinical Genomics; Pedigree
(a)(15)(i)
§170.204(b)(1) HL7 Version 3 Implementation Guide: URL-Based Implementations of the Context-Aware Information Retrieval (Infobutton) Domain
Express Procedures according to the standard specified at §170.207(b)(4) (45 CFR162.1002(c)(3): ICD-10-PCS)
(b)(2)(ii)(C) Transmit health information to a Third Party using the standards specified at §170.202(b) and (c) (SOAP Protocols)
(f)(3)
Ambulatory setting only – Create syndrome-based public health surveillance information for transmission using the standard specified at §170.205(d)(3) (urgent care visit scenario)
Common MU Data Set (15)
Express Procedures according to the standard specified at §170.207(b)(3) (45 CFR162.1002(a)(4): Code on Dental Procedures and Nomenclature)
(e)(1) View, download and transmit data to a third party using the standard specified at §170.202(d) (Edge Protocol IG version 1.1)
(f)(7) Ambulatory setting only – transmission to public health agencies – syndromic surveillance - Create Data Elements
Test Results Summary for 2014 Edition EHR Certification17-2999-R-0009-PRA V1.0, March 6, 2017
Ambulatory Inpatient No CQMs tested*For a list of the 2014 Clinical Quality Measures, please reference http://www.cms.gov (navigation: 2014 Clinical Quality Measures)
Ambulatory CQMs
Inpatient CQMs
Test Results Summary for 2014 Edition EHR Certification17-2999-R-0009-PRA V1.0, March 6, 2017
Quality Management System** B Privacy and Security C*Required if any of the following were tested: (a)(1), (a)(2), (a)(6), (a)(7), (a)(8), (a)(16), (a)(18), (a)(19), (a)(20), (b)(3), (b)(4), (b)(9)**Required for every EHR product
Take the participant to the starting point for the task. - FNC
The patient you are examining 5’ 10” 285 lbs. male needs a differential diagnosis of 034.0
Streptococcal Sore Throat and needs a 87880 rapid strep to confirm diagnosis. Enter Vitals, Dx
and SP into the system
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed
Comments:
Task Time: _____________ Seconds
Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, enter 5 feet 10 inches and 285 lbs 2. go to the DX tab and Enter the diagnosis 034.0 Streptococcal Sore Throat 3. Note Alert for Obesity and Hypertension in CDS slider 4. Still inside FNC, go to the SP tab 5. Enter procedure code 87880 Strep A Assay 6. Still inside FNC, click the Close button to close the note, save the note as incomplete 7. Click okay.
Comments:
Observed Errors and Verbalizations:
Comments:
Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5)
Task 3: Creation of a Procedure Task Message to the Nurses - Ed Wood (5 Minutes)
Take the participant to the starting point for the task. - FNC
A patient you saw earlier that requested an order for a test at a different lab wants the lab found it was not covered by his insurance. He wants it to be performed in your office. You need to order a rapid strep test (87880) for the patient, as he is on his way back into the office.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed
Comments:
Task Time: _____________ Seconds
Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open the scheduler 2. Find the appointment for Ed Wood 3. Click the Blue Folder (Open/Create note) 4. Click New->Procedure Task Message
a. Enter the Nurses b. Click Okay
5. Click to close the note a. Click Okay
Comments:
Observed Errors and Verbalizations:
Comments:
Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5)
Take the participant to the starting point for the task. - DESKTOP
You have a lab result request message in your inbox to process. You need to review and approve the request.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed
Comments:
Task Time: _____________ Seconds
Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
Approval of Lab Results
1. Locate the Lab Result Approval message in the Desktop Message pane 2. Click on the Time and Date Hyperlink or Plus (+) sign next to the message 3. Click on Process Message 4. From the Modify Message window 5. After review of the results, click the Approved All button
a. Your user (provider) name will auto populate along with the current date 6. Click Complete
a. This will simultaneously set the approved lab results and complete the message
Comments:
Observed Errors and Verbalizations:
Comments:
Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5)
Task 6: Drug Allergy Alert in Rx Interaction – Mary Wood (5 Minutes)
Take the participant to the starting point for the task. - DESKTOP
Need to prescribe Keflex to Mary Woods chart 1 tablet per day by mouth for 10 days
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed
Comments:
Task Time: _____________ Seconds
Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Click Rx Tab
6. In the Drug field, enter Keflex
7. Click the find control
8. Select Keflex 500 mg
9. Pop up: Receive Drug Screening Warning: ALLERGY ALERT: The use of Keflex cross-sensitivity reaction based on a reported history of allergy to PENICILLINS. Do you want to continue? Click Yes
Comments:
Observed Errors and Verbalizations:
Comments:
Rating: Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5)
Task 8: Medication List in OPS – Mary Wood (5 Minutes)
Take the participant to the starting point for the task. - DESKTOP
You are about to walk into an exam room for a med check on a patient. Go to One Page
Summary and review the patient’s drug list.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed
Comments:
Task Time: _____________ Seconds
Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Go to Patient Demographics 2. Click Patient 3. Click One Page Summary 4. Click hyperlink in index for Current Medication 5. Verify the data is displayed correctly
Comments:
Observed Errors and Verbalizations:
Comments:
Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5)
Task 9: Medication List in Hx Tab with Filter – Mary Wood (5 Minutes)
Take the participant to the starting point for the task. - DESKTOP
Previously very ill patient with a very large medication history is asking about her current medications. You want to compare the active/inactive medications with the maintenance medication list (which are two different filters in the system Go to Hx Tab and change the filter to show only Active Medications and them maintenance medications.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed
Comments:
Task Time: _____________ Seconds
Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, go to the HX tab 2. Click on the Medication History 3. Review the items on the list 4. Click the search icon to change the filter 5. Change the filter to maintenance 6. Review the Maintenance Medications
Comments:
Observed Errors and Verbalizations:
Comments:
Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5)
Report based on ISO/IEC 25062:2006 Common Industry Format for Usability Test Reports
Aprima 2014 Date of Usability Test: 05/21/13-05/23/13 Date of Report: 05/27/13 Report Prepared By: Aprima Medical Software Project Management Cornell Hardman (214) 466-8107 Aprima Medical Software 3330 Keller Springs Road Suite 201 Carrollton, TX 75006
Table of Contents EXECUTIVE SUMMARY ................................................................................................................. 3
Major findings ............................................................................................................................... 5
Areas for improvement ................................................................................................................. 5
the participant schedule, and included each participant's demographic
characteristics as provided by the recruiting firm.
STUDY DESIGN
Overall, the objective of this test was to uncover areas where the application
performed well - that is, effectively, efficiently, and with satisfaction - and areas
where the application failed to meet the needs of the participants. The data
from this test may serve as a baseline for future tests with an updated version
of the same EHR and/or comparison with other EHRs provided the same tasks
are used. In short, this testing serves as both a means to record or benchmark
current usability, but also to identify areas where improvements must be made.
During the usability test, participants interacted with a single EHR. Each
participant used the system in the same location, and was provided with the
same instructions. The system was evaluated for effectiveness, efficiency and
satisfaction as defined by measures collected and analyzed for each
participant:
Number of tasks successfully completed within the allotted time without assistance
Time to complete the tasks Number and types of errors Path deviations Participant's verbalizations (comments) Participant's satisfaction ratings of the system
Additional information about the various measures can be found in
have successfully completed the task. I would like to request that you
not talk aloud or verbalize while you are doing the tasks. I will ask you
your impressions about the task once you are done.
Participants were then given 13 tasks to complete. Tasks are listed in the
moderator's guide in the Appendix.
USABILITY METRICS
According to the NIST Guide to the Processes Approach for Improving the
Usability of Electronic Health Records, EHRs should support a process that
provides a high level of usability for all users. The goal is for users to interact
with the system effectively, efficiently, and with an acceptable level of
satisfaction. To this end, metrics for effectiveness, efficiency and user
satisfaction were captured during the usability testing. The goals of the test
were to assess:
1. Effectiveness of EHRUT by measuring participant success rates and errors
2. Efficiency of EHRUT by measuring the average task time and path
deviations
3. Satisfaction with EHRUT by measuring ease of use ratings
DATA SCORING
The following table (Table 1) details how tasks were scored, errors evaluated,
and the time data analyzed.
Measures Rational and Scoring
Effectiveness: Task Success
A task was counted as a "Success" if the participant was able to achieve the correct outcome, without assistance, within the time allotted on a per task basis. The total number of successes were calculated for each task and then divided by the total number of times that task was attempted. The results are provided as a percentage.
Task times were recorded for successes. Observed task times divided by the optimal time for each task is a measure of optimal efficiency. Optimal task performance time, as benchmarked by expert performance under realistic conditions, is recorded when constructing tasks. Target task times used for task times in the Moderator's Guide must be operationally defined by taking multiple measures of optimal performance and multiplying by some factor that allows some time buffer because the participants are presumably not trained to expert performance. Scoring used a factor of 2. Thus, if expert, optimal performance on a task was 80 seconds then allotted task time performance was 80 * 2 = 160 seconds. This ratio should be aggregated across tasks and reported with mean and variance scores.
Effectiveness: Task Failures
If the participant abandoned the task, did not reach the correct answer or performed it incorrectly, or reached the end of the allotted time before successful completion, the task was counted as a "Failure." No task times were taken for errors. The total number of errors was calculated for each task and then divided by the total number of times that task was attempted. Not all deviations would be counted as errors. This should also be expressed as the mean number of failed tasks per participant. On a qualitative level, an enumeration of errors and error types were collected.
Efficiency: Task Deviations
The participant's path (i.e., steps) through the application was recorded. Deviations occur if the participant, for example, went to a wrong screen, clicked on an incorrect menu item, followed an incorrect link, or interacted incorrectly with an on-screen control. This path was compared to the optimal path. The number of steps in the observed path is divided by the number of optimal steps in order to provide a ratio of path deviation. It is strongly recommended that task deviations be reported. Optimal paths (i.e., procedural steps) should be recorded when constructing tasks.
Efficiency: Task Time
Each task was timed from when the administrator said "Begin" until the participant said, "Done." If he or she failed to say "Done," the time was stopped when the participant stopped performing the task. Only task times for tasks that were successfully completed were included in the average task time analysis. Average time per task was calculated for each task. Variance measures (standard deviation and standard error) were also calculated.
Satisfaction: Participant's subjective impression of the ease of use of the
Task Rating application was measured by administering both a simple post-task question as well as a post-session questionnaire. After each task, the participant was asked to rate "Overall, this task was:" on a scale of 1 (Very Difficult) to 5 (Very Easy). These data are averaged across participants. Common convention is that average ratings for systems judged easy to use should be 3.3 or above. To measure participants' confidence in and likeability of the EHRUT overall, the testing team administered the System Usability Scale (SUS) post-test questionnaire. Questions included, "I think I would like to use this system frequently," "I thought the system was easy to use," and "I would imagine that most people would learn to use this system very quickly." See full System Usability Score questionnaire in Appendix 5.
Table 1. Details of how observed data were scored.
The purpose of a screener to ensure that the participants selected represent
the target user population as closely as possible. (Portions of this sample
screener are taken from www.usability.gov/templates/index.html#Usability and
adapted for use.)
Recruiting Script for Recruiting Firm
Hello, my name is _______________, calling from [Insert name of recruiting
firm]. We are recruiting individuals to participate in a usability study for an
electronic health record. We would like to ask you a few questions to see if
you qualify and if would like to participate. This should only take a few minutes
of your time. This is strictly for research purposes. If you are interested and
qualify for the study, you will be paid to participate. Can I ask you a few
questions?
Customize this by dropping or adding questions so that it reflects your EHR's
primary audience
1. [If not obvious] Are you male or female? [Recruit a mix of participants]
2. Have you participated in a focus group or usability test in the past xx months? [If yes, Terminate]
3. Do you, or does anyone in your home, work in marketing research, usability research, web design [If yes, Terminate]
4. Do you, or does anyone in your home, have a commercial or research interest in an electronic health record software or consulting company? [If yes, Terminate]
5. Which of the following best describes your age? [23 to 39; 40 to 59; 60 and older] [Recruit Mix]
6. Which of the following best describes your race or ethnic group? [e.g., Caucasian, Asian, Black/African-American, Latino/a or Hispanic, etc.]
7. Do you require any assistive technologies to use a computer? [if so, please describe] Professional Demographics Customize this to reflect your EHR's primary audience
8. What is your current position and title? (Must be healthcare provider)
□ RN: Specialty _______________________
□ Physician: Specialty _______________________
□ Resident: Specialty _______________________
□ Medical Assistant _______________________
□ Administrative Staff
□ Other [Terminate]
9. How long have you held this position?
10. Describe your work location (or affiliation) and environment? (Recruit according to the intended users of the application. e.g., private practice, health system, government clinic, etc.)
11. Which of the following describes your highest level of education? [e.g., high school graduate/GED, some college, college graduate (RN, BSN), postgraduate (MD/PhD), other (explain)
12. Besides reading email, what professional activities do you do on the computer? [e.g., access EHR, research; reading news; shopping/banking; digital pictures; programming/word processing, etc.] [If no computer use at all, Terminate]
13. About how many hours per week do you spend on the computer? [Recruit according to the demographics of the intended users, e.g., 0 to 10, 11 to 25, 26+ hours per week]
14. What computer platform do you usually use? [e.g., Mac, Windows, etc.]
15. What Internet browser(s) do you usually use? [e.g., Firefox, IE, AOL, etc.]
16. In the last month, how often have you used an electronic health record?
17. How many years have you used an electronic health record?
18. How many EHRs do you use or are you familiar with?
19. How does your work environment handle patient records? [Recruit according to the demographics of the intended users]
Appendix 3: NON-DISCLOSURE AGREEMENT AND INFORMED CONSENT FORM
Non-Disclosure Agreement THIS AGREEMENT is entered into as of _________________, 2013, between ________________ ("the Participant") and the testing organization Aprima Medical Software located at 3330 Keller Springs Rd. Suite 201, Carrollton, TX 75006. The Participant acknowledges his or her voluntary participation in today's usability study may bring the Participant into possession of Confidential Information. The term "Confidential Information" means all technical and commercial information of a proprietary or confidential nature which is disclosed by Test Company, or otherwise acquired by the Participant, in the course of today's study. By way of illustration, but not limitation, Confidential Information includes trade secrets, processes, formulae, data, know-how, products, designs, drawings, computer aided design files and other computer files, computer software, ideas, improvements, inventions, training methods and materials, marketing techniques, plans, strategies, budgets, financial information, or forecasts. Any information the Participant acquires relating to this product during this study is confidential and proprietary to Test Company and is being disclosed solely for the purposes of the Participant's participation in today's usability study. By signing this form the Participant acknowledges that s/he will receive monetary compensation for feedback and will not disclose this confidential information obtained today to anyone else or any other organizations. Participant's printed name: ___________________________________________________ Signature: __________________________________________________________________
Informed Consent Test Company would like to thank you for participating in this study. The purpose of this study is to evaluate an electronic health records system. If you decide to participate, you will be asked to perform several tasks using the prototype and give your feedback. The study will last about 30 minutes. At the conclusion of the test, you will be compensated for your time. Agreement I understand and agree that as a voluntary participant in the present study conducted by Test Company I am free to withdraw consent or discontinue participation at any time. I understand and agree to participate in the study conducted and videotaped by the Test Company. I understand and consent to the use and release of the videotape by Test Company. I understand that the information and videotape is for research purposes only and that my name and image will not be used for any purpose other than research. I relinquish any rights to the videotape and understand the videotape may be copied and used by Test Company without further permission. I understand and agree that the purpose of this study is to make software applications more useful and usable in the future. I understand and agree that the data collected from this study may be shared with outside of Test Company and Test Company's client. I understand and agree that data confidentiality is assured, because only de- identified data - i.e., identification numbers not names - will be used in analysis and reporting of the results. I agree to immediately raise any concerns or areas of discomfort with the study administrator. I understand that I can leave at any time. Please check one of the following: □ YES, I have read the above statement and agree to be a participant. □ NO, I choose not to participate in this study. Signature: _________________________________ Date: _______________________
Only four tasks are presented here for illustration. EHRUT Usability Test Moderator's Guide Administrator _____________________
Data Logger _____________________
Date _________________ Time _____________________
Participant # _________
Location _____________________
Prior to testing
■ Confirm schedule with Participants ■ Ensure EHRUT lab environment is running properly ■ Ensure Consent forms are complete for all participants ■ Ensure lab and data recording equipment is running properly
Prior to each participant: ■ Reset application ■ Restore application to base state using script restoredb.bat ■ Start session recordings with GTM Recording
Prior to each task: ■ Reset application to starting point for next task
After each participant: ■ End session recordings with tool ■ Fill out all paper work and acknowledgement form.
After all testing ■ Scan all forms and shred originals ■ Back up all video and data files
Orientation (5 minutes) Thank you for participating in this study. Our session today will last 2 hours today. During that time you will take a look at an electronic health record system. I will ask you to complete a few tasks using this system and answer some questions. We are interested in how easy (or how difficult) this system is to use, what in it would be useful to you, and how we could improve it. You will be asked to complete these tasks on your own trying to do them as quickly as possible with the fewest possible errors or deviations. Do not do anything more than asked. If you get lost or have difficulty I cannot answer help you with anything to do with the system itself. Please save your detailed comments until the end of a task or the end of the session as a whole when we can discuss freely. I did not have any involvement in its creation, so please be honest with your opinions. The product you will be using today is describe the state of the application, i.e., production version, early prototype, etc. Some of the data may not make sense as it is placeholder data. We are recording the audio and screenshots of our session today. All of the information that you provide will be kept confidential and your name will not be associated with your comments at any time. Do you have any questions or concerns? Preliminary Questions (5 minutes) What is your job title / appointment? How long have you been working in this role? What are some of your main responsibilities? Tell me about your experience with electronic health records.
Preview: First Impressions (6 Minutes) This is the application you will be working with. Have you heard of it? Yes ___ No ___ If so, tell me what you know about it. Show test participant the EHRUT. Please don't click on anything just yet. What do you notice? What are you able to do here? Please be specific. Notes / Comments:
Task 1: Create an Order – Ed Wood (5 Minutes) Take the participant to the starting point for the task. - FNC The patient you are examining 5’ 10” 285 lbs. male needs a differential diagnosis of 034.0 Streptococcal Sore Throat and needs a 87880 rapid strep to confirm diagnosis. Enter Vitals, Dx and SP into the system Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, enter 5 feet 10 inches and 285 lbs 2. go to the DX tab and Enter the diagnosis 034.0 Streptococcal Sore Throat 3. Note Alert for Obesity and Hypertension in CDS slider 4. Still inside FNC, go to the SP tab 5. Enter procedure code 87880 Strep A Assay 6. Still inside FNC, click the Close button to close the note, save the note as incomplete 7. Click okay.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 2: Utilize an existing Clinical Decision Support Alert – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You run are in consultation with a patient and his parent who is 71 years old. You want to quickly see if there are any Clinical Support Alerts for the parent. Go to the Appointment to review CDS Alerts and look at the source information for the alert. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
Open Patient Norman Wood
Open Update Appointment from Envelope
Open Clinical Decision Support Tab
Note Fall Risk Rule on Slider
Click on the Hyperlink for Fall Risk Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 3: Creation of a Procedure Task Message to the Nurses - Ed Wood (5 Minutes) Take the participant to the starting point for the task. - FNC
A patient you saw earlier that requested an order for a test at a different lab wants the lab found it was not covered by his insurance. He wants it to be performed in your office. You need to order a rapid strep test (87880) for the patient, as he is on his way back into the office.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open the scheduler 2. Find the appointment for Ed Wood 3. Click the Blue Folder (Open/Create note) 4. Click New->Procedure Task Message
a. Enter the Nurses b. Click Okay
5. Click to close the note a. Click Okay
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 4: Approve a Lab result (5 Minutes) Take the participant to the starting point for the task. - DESKTOP
You have a lab result request message in your inbox to process. You need to review and approve the request.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations Approval of Lab Results
1. Locate the Lab Result Approval message in the Desktop Message pane 2. Click on the Time and Date Hyperlink or Plus (+) sign next to the message 3. Click on Process Message 4. From the Modify Message window 5. After review of the results, click the Approved All button
a. Your user (provider) name will auto populate along with the current date 6. Click Complete
a. This will simultaneously set the approved lab results and complete the message Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 5: Document Drug Allergy in History – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are examining reports to you that she has been taking no meds because she has an anaphylactic reaction to Penicillins. Please document the allergy in History Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Find Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Click Drug Allergy
6. In the Allergen column, select Penicillins.
7. In the Reaction column, select anaphylaxis.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 6: Drug Allergy Alert in Rx Interaction – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP Need to prescribe Keflex to Mary Woods chart 1 tablet per day by mouth for 10 days Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Click Rx Tab
6. In the Drug field, enter Keflex
7. Click the find control
8. Select Keflex 500 mg
9. Pop up: Receive Drug Screening Warning: ALLERGY ALERT: The use of Keflex cross-sensitivity reaction based on a reported history of allergy to PENICILLINS. Do you want to continue? Click Yes
Comments: Observed Errors and Verbalizations: Comments: Rating: Overall, this task was: ___________ Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 7: Drug Drug Interaction – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP An agitated patient wants you to prescribe Prozac immediately. 20mg 1 time per day by mouth. Please prescribe the medication. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Find Mary Wood that has an appointment scheduled.
2. Click the Open/Create Note icon
3. FNC
4. Click Rx Tab
5. In the Drug field, enter Prozac
6. Click the find control
7. Select Prozac 20mg tablet
8. Pop up: Receive Drug Screening Warning: Duplicate Therapy: The use of Prozac is a duplicate therapy with Zoloft 50 mg. Do you want to continue?
a. Click No
9. Print -> Save and print Button
a. Print Dialog
10. Click ok to save and exit the note
Comments: Observed Errors and Verbalizations: Comments: Rating: Overall, this task was: ___________ Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 8: Medication List in OPS – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You are about to walk into an exam room for a med check on a patient. Go to One Page Summary and review the patient’s drug list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Go to Patient Demographics 2. Click Patient 3. Click One Page Summary 4. Click hyperlink in index for Current Medication 5. Verify the data is displayed correctly
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 9: Medication List in Hx Tab with Filter – Mary Wood (5 Minutes)
Take the participant to the starting point for the task. - DESKTOP
Previously very ill patient with a very large medication history is asking about her current medications. You want to compare the active/inactive medications with the maintenance medication list (which are two different filters in the system Go to Hx Tab and change the filter to show only Active Medications and them maintenance medications.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, go to the HX tab 2. Click on the Medication History 3. Review the items on the list 4. Click the search icon to change the filter 5. Change the filter to maintenance 6. Review the Maintenance Medications
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 10: Rx Refill Complete (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You have a few minutes to complete your drug refill request messages Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Messages
2. Locate message
3. Click on patient’s blue envelope.
4. Select Process Rx Refill
5. Medication History screen
6. Select the drug by clicking the Refill button.
7. Sig Writer screen
a. Verify information in sig
8. Click Ok
a. Return to the Modify Message screen
9. Click Complete.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 11: import Allergies from external list - Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are seeing has a C-CDA that needs to be checked against your record. Start with reconciling the Allergy list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open attachments 2. Go to attachments – Allergies - CCD 3. Click the import allergies icon 4. Sulfasalazine -> Add 5. Penicillin V -> Merge/Add 6. Carbamazepine -> ignore/remove 7. Click Reconcile 8. Go to Hx
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 12: Import Medications from external list – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are seeing has a C-CDA that needs to be checked against your record. Start with reconciling the Medication list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open attachments 2. View the medication CCD 3. Click the import medications icon 4. Simvastatin -> Add 5. Lorazepam -> Add 6. Lisinopril -> Add/Merge 7. Click reconcile 8. Go to patient Hx – Medications
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 13: Verify import in Allergy list and Medication List – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP Please validate that the import of Allergy list and Medication list import has the expected information Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Find Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Note the CDS rule for the combination of the new allergy and medication
6. Click Drug Allergy
a. Verify the information is correct from the import
7. Click on the Medication History
a. Verify the information is correct from the import
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Final Questions (10 Minutes) What was your overall impression of this system? What aspects of the system did you like most? What aspects of the system did you like least? Were there any features that you were surprised to see? What features did you expect to encounter but did not see? That is, is there anything that is missing in this application? Compare this system to other systems you have used. Would you recommend this system to your colleagues? Administer the SUS
Appendix 6: INCENTIVE RECEIPT AND ACKNOWLEDGMENT FORM
Acknowledgement of Receipt I hereby acknowledge receipt of $ _____ for my participation in a research study run by Aprima Medical Software. Printed Name: _____________________________________________________________ Address: __________________________________________________________________ __________________________________________________________________________ Signature: _______________________________________________ Date: ____________ Usability Researcher: ________________________________________________________ Signature of Usability Researcher: ____________________________ Date: ______________ Witness: ___________________________________________________________________ Witness Signature: ________________________________________ Date: ______________
Report based on ISO/IEC 25062:2006 Common Industry Format for Usability Test Reports
Aprima 2014 Date of Usability Test: 05/21/13-05/23/13 Date of Report: 05/27/13 Report Prepared By: Aprima Medical Software Project Management Cornell Hardman (214) 466-8107 Aprima Medical Software 3330 Keller Springs Road Suite 201 Carrollton, TX 75006
Table of Contents EXECUTIVE SUMMARY ................................................................................................................. 3
Major findings ............................................................................................................................... 5
Areas for improvement ................................................................................................................. 5
the participant schedule, and included each participant's demographic
characteristics as provided by the recruiting firm.
STUDY DESIGN
Overall, the objective of this test was to uncover areas where the application
performed well - that is, effectively, efficiently, and with satisfaction - and areas
where the application failed to meet the needs of the participants. The data
from this test may serve as a baseline for future tests with an updated version
of the same EHR and/or comparison with other EHRs provided the same tasks
are used. In short, this testing serves as both a means to record or benchmark
current usability, but also to identify areas where improvements must be made.
During the usability test, participants interacted with a single EHR. Each
participant used the system in the same location, and was provided with the
same instructions. The system was evaluated for effectiveness, efficiency and
satisfaction as defined by measures collected and analyzed for each
participant:
Number of tasks successfully completed within the allotted time without assistance
Time to complete the tasks Number and types of errors Path deviations Participant's verbalizations (comments) Participant's satisfaction ratings of the system
Additional information about the various measures can be found in
have successfully completed the task. I would like to request that you
not talk aloud or verbalize while you are doing the tasks. I will ask you
your impressions about the task once you are done.
Participants were then given 13 tasks to complete. Tasks are listed in the
moderator's guide in the Appendix.
USABILITY METRICS
According to the NIST Guide to the Processes Approach for Improving the
Usability of Electronic Health Records, EHRs should support a process that
provides a high level of usability for all users. The goal is for users to interact
with the system effectively, efficiently, and with an acceptable level of
satisfaction. To this end, metrics for effectiveness, efficiency and user
satisfaction were captured during the usability testing. The goals of the test
were to assess:
1. Effectiveness of EHRUT by measuring participant success rates and errors
2. Efficiency of EHRUT by measuring the average task time and path
deviations
3. Satisfaction with EHRUT by measuring ease of use ratings
DATA SCORING
The following table (Table 1) details how tasks were scored, errors evaluated,
and the time data analyzed.
Measures Rational and Scoring
Effectiveness: Task Success
A task was counted as a "Success" if the participant was able to achieve the correct outcome, without assistance, within the time allotted on a per task basis. The total number of successes were calculated for each task and then divided by the total number of times that task was attempted. The results are provided as a percentage.
Task times were recorded for successes. Observed task times divided by the optimal time for each task is a measure of optimal efficiency. Optimal task performance time, as benchmarked by expert performance under realistic conditions, is recorded when constructing tasks. Target task times used for task times in the Moderator's Guide must be operationally defined by taking multiple measures of optimal performance and multiplying by some factor that allows some time buffer because the participants are presumably not trained to expert performance. Scoring used a factor of 2. Thus, if expert, optimal performance on a task was 80 seconds then allotted task time performance was 80 * 2 = 160 seconds. This ratio should be aggregated across tasks and reported with mean and variance scores.
Effectiveness: Task Failures
If the participant abandoned the task, did not reach the correct answer or performed it incorrectly, or reached the end of the allotted time before successful completion, the task was counted as a "Failure." No task times were taken for errors. The total number of errors was calculated for each task and then divided by the total number of times that task was attempted. Not all deviations would be counted as errors. This should also be expressed as the mean number of failed tasks per participant. On a qualitative level, an enumeration of errors and error types were collected.
Efficiency: Task Deviations
The participant's path (i.e., steps) through the application was recorded. Deviations occur if the participant, for example, went to a wrong screen, clicked on an incorrect menu item, followed an incorrect link, or interacted incorrectly with an on-screen control. This path was compared to the optimal path. The number of steps in the observed path is divided by the number of optimal steps in order to provide a ratio of path deviation. It is strongly recommended that task deviations be reported. Optimal paths (i.e., procedural steps) should be recorded when constructing tasks.
Efficiency: Task Time
Each task was timed from when the administrator said "Begin" until the participant said, "Done." If he or she failed to say "Done," the time was stopped when the participant stopped performing the task. Only task times for tasks that were successfully completed were included in the average task time analysis. Average time per task was calculated for each task. Variance measures (standard deviation and standard error) were also calculated.
Satisfaction: Participant's subjective impression of the ease of use of the
Task Rating application was measured by administering both a simple post-task question as well as a post-session questionnaire. After each task, the participant was asked to rate "Overall, this task was:" on a scale of 1 (Very Difficult) to 5 (Very Easy). These data are averaged across participants. Common convention is that average ratings for systems judged easy to use should be 3.3 or above. To measure participants' confidence in and likeability of the EHRUT overall, the testing team administered the System Usability Scale (SUS) post-test questionnaire. Questions included, "I think I would like to use this system frequently," "I thought the system was easy to use," and "I would imagine that most people would learn to use this system very quickly." See full System Usability Score questionnaire in Appendix 5.
Table 1. Details of how observed data were scored.
The purpose of a screener to ensure that the participants selected represent
the target user population as closely as possible. (Portions of this sample
screener are taken from www.usability.gov/templates/index.html#Usability and
adapted for use.)
Recruiting Script for Recruiting Firm
Hello, my name is _______________, calling from [Insert name of recruiting
firm]. We are recruiting individuals to participate in a usability study for an
electronic health record. We would like to ask you a few questions to see if
you qualify and if would like to participate. This should only take a few minutes
of your time. This is strictly for research purposes. If you are interested and
qualify for the study, you will be paid to participate. Can I ask you a few
questions?
Customize this by dropping or adding questions so that it reflects your EHR's
primary audience
1. [If not obvious] Are you male or female? [Recruit a mix of participants]
2. Have you participated in a focus group or usability test in the past xx months? [If yes, Terminate]
3. Do you, or does anyone in your home, work in marketing research, usability research, web design [If yes, Terminate]
4. Do you, or does anyone in your home, have a commercial or research interest in an electronic health record software or consulting company? [If yes, Terminate]
5. Which of the following best describes your age? [23 to 39; 40 to 59; 60 and older] [Recruit Mix]
6. Which of the following best describes your race or ethnic group? [e.g., Caucasian, Asian, Black/African-American, Latino/a or Hispanic, etc.]
7. Do you require any assistive technologies to use a computer? [if so, please describe] Professional Demographics Customize this to reflect your EHR's primary audience
8. What is your current position and title? (Must be healthcare provider)
□ RN: Specialty _______________________
□ Physician: Specialty _______________________
□ Resident: Specialty _______________________
□ Medical Assistant _______________________
□ Administrative Staff
□ Other [Terminate]
9. How long have you held this position?
10. Describe your work location (or affiliation) and environment? (Recruit according to the intended users of the application. e.g., private practice, health system, government clinic, etc.)
11. Which of the following describes your highest level of education? [e.g., high school graduate/GED, some college, college graduate (RN, BSN), postgraduate (MD/PhD), other (explain)
12. Besides reading email, what professional activities do you do on the computer? [e.g., access EHR, research; reading news; shopping/banking; digital pictures; programming/word processing, etc.] [If no computer use at all, Terminate]
13. About how many hours per week do you spend on the computer? [Recruit according to the demographics of the intended users, e.g., 0 to 10, 11 to 25, 26+ hours per week]
14. What computer platform do you usually use? [e.g., Mac, Windows, etc.]
15. What Internet browser(s) do you usually use? [e.g., Firefox, IE, AOL, etc.]
16. In the last month, how often have you used an electronic health record?
17. How many years have you used an electronic health record?
18. How many EHRs do you use or are you familiar with?
19. How does your work environment handle patient records? [Recruit according to the demographics of the intended users]
Appendix 3: NON-DISCLOSURE AGREEMENT AND INFORMED CONSENT FORM
Non-Disclosure Agreement THIS AGREEMENT is entered into as of _________________, 2013, between ________________ ("the Participant") and the testing organization Aprima Medical Software located at 3330 Keller Springs Rd. Suite 201, Carrollton, TX 75006. The Participant acknowledges his or her voluntary participation in today's usability study may bring the Participant into possession of Confidential Information. The term "Confidential Information" means all technical and commercial information of a proprietary or confidential nature which is disclosed by Test Company, or otherwise acquired by the Participant, in the course of today's study. By way of illustration, but not limitation, Confidential Information includes trade secrets, processes, formulae, data, know-how, products, designs, drawings, computer aided design files and other computer files, computer software, ideas, improvements, inventions, training methods and materials, marketing techniques, plans, strategies, budgets, financial information, or forecasts. Any information the Participant acquires relating to this product during this study is confidential and proprietary to Test Company and is being disclosed solely for the purposes of the Participant's participation in today's usability study. By signing this form the Participant acknowledges that s/he will receive monetary compensation for feedback and will not disclose this confidential information obtained today to anyone else or any other organizations. Participant's printed name: ___________________________________________________ Signature: __________________________________________________________________
Informed Consent Test Company would like to thank you for participating in this study. The purpose of this study is to evaluate an electronic health records system. If you decide to participate, you will be asked to perform several tasks using the prototype and give your feedback. The study will last about 30 minutes. At the conclusion of the test, you will be compensated for your time. Agreement I understand and agree that as a voluntary participant in the present study conducted by Test Company I am free to withdraw consent or discontinue participation at any time. I understand and agree to participate in the study conducted and videotaped by the Test Company. I understand and consent to the use and release of the videotape by Test Company. I understand that the information and videotape is for research purposes only and that my name and image will not be used for any purpose other than research. I relinquish any rights to the videotape and understand the videotape may be copied and used by Test Company without further permission. I understand and agree that the purpose of this study is to make software applications more useful and usable in the future. I understand and agree that the data collected from this study may be shared with outside of Test Company and Test Company's client. I understand and agree that data confidentiality is assured, because only de- identified data - i.e., identification numbers not names - will be used in analysis and reporting of the results. I agree to immediately raise any concerns or areas of discomfort with the study administrator. I understand that I can leave at any time. Please check one of the following: □ YES, I have read the above statement and agree to be a participant. □ NO, I choose not to participate in this study. Signature: _________________________________ Date: _______________________
Only four tasks are presented here for illustration. EHRUT Usability Test Moderator's Guide Administrator _____________________
Data Logger _____________________
Date _________________ Time _____________________
Participant # _________
Location _____________________
Prior to testing
■ Confirm schedule with Participants ■ Ensure EHRUT lab environment is running properly ■ Ensure Consent forms are complete for all participants ■ Ensure lab and data recording equipment is running properly
Prior to each participant: ■ Reset application ■ Restore application to base state using script restoredb.bat ■ Start session recordings with GTM Recording
Prior to each task: ■ Reset application to starting point for next task
After each participant: ■ End session recordings with tool ■ Fill out all paper work and acknowledgement form.
After all testing ■ Scan all forms and shred originals ■ Back up all video and data files
Orientation (5 minutes) Thank you for participating in this study. Our session today will last 2 hours today. During that time you will take a look at an electronic health record system. I will ask you to complete a few tasks using this system and answer some questions. We are interested in how easy (or how difficult) this system is to use, what in it would be useful to you, and how we could improve it. You will be asked to complete these tasks on your own trying to do them as quickly as possible with the fewest possible errors or deviations. Do not do anything more than asked. If you get lost or have difficulty I cannot answer help you with anything to do with the system itself. Please save your detailed comments until the end of a task or the end of the session as a whole when we can discuss freely. I did not have any involvement in its creation, so please be honest with your opinions. The product you will be using today is describe the state of the application, i.e., production version, early prototype, etc. Some of the data may not make sense as it is placeholder data. We are recording the audio and screenshots of our session today. All of the information that you provide will be kept confidential and your name will not be associated with your comments at any time. Do you have any questions or concerns? Preliminary Questions (5 minutes) What is your job title / appointment? How long have you been working in this role? What are some of your main responsibilities? Tell me about your experience with electronic health records.
Preview: First Impressions (6 Minutes) This is the application you will be working with. Have you heard of it? Yes ___ No ___ If so, tell me what you know about it. Show test participant the EHRUT. Please don't click on anything just yet. What do you notice? What are you able to do here? Please be specific. Notes / Comments:
Task 1: Create an Order – Ed Wood (5 Minutes) Take the participant to the starting point for the task. - FNC The patient you are examining 5’ 10” 285 lbs. male needs a differential diagnosis of 034.0 Streptococcal Sore Throat and needs a 87880 rapid strep to confirm diagnosis. Enter Vitals, Dx and SP into the system Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, enter 5 feet 10 inches and 285 lbs 2. go to the DX tab and Enter the diagnosis 034.0 Streptococcal Sore Throat 3. Note Alert for Obesity and Hypertension in CDS slider 4. Still inside FNC, go to the SP tab 5. Enter procedure code 87880 Strep A Assay 6. Still inside FNC, click the Close button to close the note, save the note as incomplete 7. Click okay.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 2: Utilize an existing Clinical Decision Support Alert – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You run are in consultation with a patient and his parent who is 71 years old. You want to quickly see if there are any Clinical Support Alerts for the parent. Go to the Appointment to review CDS Alerts and look at the source information for the alert. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
Open Patient Norman Wood
Open Update Appointment from Envelope
Open Clinical Decision Support Tab
Note Fall Risk Rule on Slider
Click on the Hyperlink for Fall Risk Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 3: Creation of a Procedure Task Message to the Nurses - Ed Wood (5 Minutes) Take the participant to the starting point for the task. - FNC
A patient you saw earlier that requested an order for a test at a different lab wants the lab found it was not covered by his insurance. He wants it to be performed in your office. You need to order a rapid strep test (87880) for the patient, as he is on his way back into the office.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open the scheduler 2. Find the appointment for Ed Wood 3. Click the Blue Folder (Open/Create note) 4. Click New->Procedure Task Message
a. Enter the Nurses b. Click Okay
5. Click to close the note a. Click Okay
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 4: Approve a Lab result (5 Minutes) Take the participant to the starting point for the task. - DESKTOP
You have a lab result request message in your inbox to process. You need to review and approve the request.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations Approval of Lab Results
1. Locate the Lab Result Approval message in the Desktop Message pane 2. Click on the Time and Date Hyperlink or Plus (+) sign next to the message 3. Click on Process Message 4. From the Modify Message window 5. After review of the results, click the Approved All button
a. Your user (provider) name will auto populate along with the current date 6. Click Complete
a. This will simultaneously set the approved lab results and complete the message Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 5: Document Drug Allergy in History – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are examining reports to you that she has been taking no meds because she has an anaphylactic reaction to Penicillins. Please document the allergy in History Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Find Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Click Drug Allergy
6. In the Allergen column, select Penicillins.
7. In the Reaction column, select anaphylaxis.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 6: Drug Allergy Alert in Rx Interaction – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP Need to prescribe Keflex to Mary Woods chart 1 tablet per day by mouth for 10 days Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Click Rx Tab
6. In the Drug field, enter Keflex
7. Click the find control
8. Select Keflex 500 mg
9. Pop up: Receive Drug Screening Warning: ALLERGY ALERT: The use of Keflex cross-sensitivity reaction based on a reported history of allergy to PENICILLINS. Do you want to continue? Click Yes
Comments: Observed Errors and Verbalizations: Comments: Rating: Overall, this task was: ___________ Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 7: Drug Drug Interaction – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP An agitated patient wants you to prescribe Prozac immediately. 20mg 1 time per day by mouth. Please prescribe the medication. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Find Mary Wood that has an appointment scheduled.
2. Click the Open/Create Note icon
3. FNC
4. Click Rx Tab
5. In the Drug field, enter Prozac
6. Click the find control
7. Select Prozac 20mg tablet
8. Pop up: Receive Drug Screening Warning: Duplicate Therapy: The use of Prozac is a duplicate therapy with Zoloft 50 mg. Do you want to continue?
a. Click No
9. Print -> Save and print Button
a. Print Dialog
10. Click ok to save and exit the note
Comments: Observed Errors and Verbalizations: Comments: Rating: Overall, this task was: ___________ Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 8: Medication List in OPS – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You are about to walk into an exam room for a med check on a patient. Go to One Page Summary and review the patient’s drug list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Go to Patient Demographics 2. Click Patient 3. Click One Page Summary 4. Click hyperlink in index for Current Medication 5. Verify the data is displayed correctly
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 9: Medication List in Hx Tab with Filter – Mary Wood (5 Minutes)
Take the participant to the starting point for the task. - DESKTOP
Previously very ill patient with a very large medication history is asking about her current medications. You want to compare the active/inactive medications with the maintenance medication list (which are two different filters in the system Go to Hx Tab and change the filter to show only Active Medications and them maintenance medications.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, go to the HX tab 2. Click on the Medication History 3. Review the items on the list 4. Click the search icon to change the filter 5. Change the filter to maintenance 6. Review the Maintenance Medications
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 10: Rx Refill Complete (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You have a few minutes to complete your drug refill request messages Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Messages
2. Locate message
3. Click on patient’s blue envelope.
4. Select Process Rx Refill
5. Medication History screen
6. Select the drug by clicking the Refill button.
7. Sig Writer screen
a. Verify information in sig
8. Click Ok
a. Return to the Modify Message screen
9. Click Complete.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 11: import Allergies from external list - Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are seeing has a C-CDA that needs to be checked against your record. Start with reconciling the Allergy list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open attachments 2. Go to attachments – Allergies - CCD 3. Click the import allergies icon 4. Sulfasalazine -> Add 5. Penicillin V -> Merge/Add 6. Carbamazepine -> ignore/remove 7. Click Reconcile 8. Go to Hx
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 12: Import Medications from external list – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are seeing has a C-CDA that needs to be checked against your record. Start with reconciling the Medication list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open attachments 2. View the medication CCD 3. Click the import medications icon 4. Simvastatin -> Add 5. Lorazepam -> Add 6. Lisinopril -> Add/Merge 7. Click reconcile 8. Go to patient Hx – Medications
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 13: Verify import in Allergy list and Medication List – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP Please validate that the import of Allergy list and Medication list import has the expected information Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Find Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Note the CDS rule for the combination of the new allergy and medication
6. Click Drug Allergy
a. Verify the information is correct from the import
7. Click on the Medication History
a. Verify the information is correct from the import
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Final Questions (10 Minutes) What was your overall impression of this system? What aspects of the system did you like most? What aspects of the system did you like least? Were there any features that you were surprised to see? What features did you expect to encounter but did not see? That is, is there anything that is missing in this application? Compare this system to other systems you have used. Would you recommend this system to your colleagues? Administer the SUS
Appendix 6: INCENTIVE RECEIPT AND ACKNOWLEDGMENT FORM
Acknowledgement of Receipt I hereby acknowledge receipt of $ _____ for my participation in a research study run by Aprima Medical Software. Printed Name: _____________________________________________________________ Address: __________________________________________________________________ __________________________________________________________________________ Signature: _______________________________________________ Date: ____________ Usability Researcher: ________________________________________________________ Signature of Usability Researcher: ____________________________ Date: ______________ Witness: ___________________________________________________________________ Witness Signature: ________________________________________ Date: ______________
Report based on ISO/IEC 25062:2006 Common Industry Format for Usability Test Reports
Aprima 2014 Date of Usability Test: 05/21/13-05/23/13 Date of Report: 05/27/13 Report Prepared By: Aprima Medical Software Project Management Cornell Hardman (214) 466-8107 Aprima Medical Software 3330 Keller Springs Road Suite 201 Carrollton, TX 75006
Table of Contents EXECUTIVE SUMMARY ................................................................................................................. 3
Major findings ............................................................................................................................... 5
Areas for improvement ................................................................................................................. 5
the participant schedule, and included each participant's demographic
characteristics as provided by the recruiting firm.
STUDY DESIGN
Overall, the objective of this test was to uncover areas where the application
performed well - that is, effectively, efficiently, and with satisfaction - and areas
where the application failed to meet the needs of the participants. The data
from this test may serve as a baseline for future tests with an updated version
of the same EHR and/or comparison with other EHRs provided the same tasks
are used. In short, this testing serves as both a means to record or benchmark
current usability, but also to identify areas where improvements must be made.
During the usability test, participants interacted with a single EHR. Each
participant used the system in the same location, and was provided with the
same instructions. The system was evaluated for effectiveness, efficiency and
satisfaction as defined by measures collected and analyzed for each
participant:
Number of tasks successfully completed within the allotted time without assistance
Time to complete the tasks Number and types of errors Path deviations Participant's verbalizations (comments) Participant's satisfaction ratings of the system
Additional information about the various measures can be found in
have successfully completed the task. I would like to request that you
not talk aloud or verbalize while you are doing the tasks. I will ask you
your impressions about the task once you are done.
Participants were then given 13 tasks to complete. Tasks are listed in the
moderator's guide in the Appendix.
USABILITY METRICS
According to the NIST Guide to the Processes Approach for Improving the
Usability of Electronic Health Records, EHRs should support a process that
provides a high level of usability for all users. The goal is for users to interact
with the system effectively, efficiently, and with an acceptable level of
satisfaction. To this end, metrics for effectiveness, efficiency and user
satisfaction were captured during the usability testing. The goals of the test
were to assess:
1. Effectiveness of EHRUT by measuring participant success rates and errors
2. Efficiency of EHRUT by measuring the average task time and path
deviations
3. Satisfaction with EHRUT by measuring ease of use ratings
DATA SCORING
The following table (Table 1) details how tasks were scored, errors evaluated,
and the time data analyzed.
Measures Rational and Scoring
Effectiveness: Task Success
A task was counted as a "Success" if the participant was able to achieve the correct outcome, without assistance, within the time allotted on a per task basis. The total number of successes were calculated for each task and then divided by the total number of times that task was attempted. The results are provided as a percentage.
Task times were recorded for successes. Observed task times divided by the optimal time for each task is a measure of optimal efficiency. Optimal task performance time, as benchmarked by expert performance under realistic conditions, is recorded when constructing tasks. Target task times used for task times in the Moderator's Guide must be operationally defined by taking multiple measures of optimal performance and multiplying by some factor that allows some time buffer because the participants are presumably not trained to expert performance. Scoring used a factor of 2. Thus, if expert, optimal performance on a task was 80 seconds then allotted task time performance was 80 * 2 = 160 seconds. This ratio should be aggregated across tasks and reported with mean and variance scores.
Effectiveness: Task Failures
If the participant abandoned the task, did not reach the correct answer or performed it incorrectly, or reached the end of the allotted time before successful completion, the task was counted as a "Failure." No task times were taken for errors. The total number of errors was calculated for each task and then divided by the total number of times that task was attempted. Not all deviations would be counted as errors. This should also be expressed as the mean number of failed tasks per participant. On a qualitative level, an enumeration of errors and error types were collected.
Efficiency: Task Deviations
The participant's path (i.e., steps) through the application was recorded. Deviations occur if the participant, for example, went to a wrong screen, clicked on an incorrect menu item, followed an incorrect link, or interacted incorrectly with an on-screen control. This path was compared to the optimal path. The number of steps in the observed path is divided by the number of optimal steps in order to provide a ratio of path deviation. It is strongly recommended that task deviations be reported. Optimal paths (i.e., procedural steps) should be recorded when constructing tasks.
Efficiency: Task Time
Each task was timed from when the administrator said "Begin" until the participant said, "Done." If he or she failed to say "Done," the time was stopped when the participant stopped performing the task. Only task times for tasks that were successfully completed were included in the average task time analysis. Average time per task was calculated for each task. Variance measures (standard deviation and standard error) were also calculated.
Satisfaction: Participant's subjective impression of the ease of use of the
Task Rating application was measured by administering both a simple post-task question as well as a post-session questionnaire. After each task, the participant was asked to rate "Overall, this task was:" on a scale of 1 (Very Difficult) to 5 (Very Easy). These data are averaged across participants. Common convention is that average ratings for systems judged easy to use should be 3.3 or above. To measure participants' confidence in and likeability of the EHRUT overall, the testing team administered the System Usability Scale (SUS) post-test questionnaire. Questions included, "I think I would like to use this system frequently," "I thought the system was easy to use," and "I would imagine that most people would learn to use this system very quickly." See full System Usability Score questionnaire in Appendix 5.
Table 1. Details of how observed data were scored.
The purpose of a screener to ensure that the participants selected represent
the target user population as closely as possible. (Portions of this sample
screener are taken from www.usability.gov/templates/index.html#Usability and
adapted for use.)
Recruiting Script for Recruiting Firm
Hello, my name is _______________, calling from [Insert name of recruiting
firm]. We are recruiting individuals to participate in a usability study for an
electronic health record. We would like to ask you a few questions to see if
you qualify and if would like to participate. This should only take a few minutes
of your time. This is strictly for research purposes. If you are interested and
qualify for the study, you will be paid to participate. Can I ask you a few
questions?
Customize this by dropping or adding questions so that it reflects your EHR's
primary audience
1. [If not obvious] Are you male or female? [Recruit a mix of participants]
2. Have you participated in a focus group or usability test in the past xx months? [If yes, Terminate]
3. Do you, or does anyone in your home, work in marketing research, usability research, web design [If yes, Terminate]
4. Do you, or does anyone in your home, have a commercial or research interest in an electronic health record software or consulting company? [If yes, Terminate]
5. Which of the following best describes your age? [23 to 39; 40 to 59; 60 and older] [Recruit Mix]
6. Which of the following best describes your race or ethnic group? [e.g., Caucasian, Asian, Black/African-American, Latino/a or Hispanic, etc.]
7. Do you require any assistive technologies to use a computer? [if so, please describe] Professional Demographics Customize this to reflect your EHR's primary audience
8. What is your current position and title? (Must be healthcare provider)
□ RN: Specialty _______________________
□ Physician: Specialty _______________________
□ Resident: Specialty _______________________
□ Medical Assistant _______________________
□ Administrative Staff
□ Other [Terminate]
9. How long have you held this position?
10. Describe your work location (or affiliation) and environment? (Recruit according to the intended users of the application. e.g., private practice, health system, government clinic, etc.)
11. Which of the following describes your highest level of education? [e.g., high school graduate/GED, some college, college graduate (RN, BSN), postgraduate (MD/PhD), other (explain)
12. Besides reading email, what professional activities do you do on the computer? [e.g., access EHR, research; reading news; shopping/banking; digital pictures; programming/word processing, etc.] [If no computer use at all, Terminate]
13. About how many hours per week do you spend on the computer? [Recruit according to the demographics of the intended users, e.g., 0 to 10, 11 to 25, 26+ hours per week]
14. What computer platform do you usually use? [e.g., Mac, Windows, etc.]
15. What Internet browser(s) do you usually use? [e.g., Firefox, IE, AOL, etc.]
16. In the last month, how often have you used an electronic health record?
17. How many years have you used an electronic health record?
18. How many EHRs do you use or are you familiar with?
19. How does your work environment handle patient records? [Recruit according to the demographics of the intended users]
Appendix 3: NON-DISCLOSURE AGREEMENT AND INFORMED CONSENT FORM
Non-Disclosure Agreement THIS AGREEMENT is entered into as of _________________, 2013, between ________________ ("the Participant") and the testing organization Aprima Medical Software located at 3330 Keller Springs Rd. Suite 201, Carrollton, TX 75006. The Participant acknowledges his or her voluntary participation in today's usability study may bring the Participant into possession of Confidential Information. The term "Confidential Information" means all technical and commercial information of a proprietary or confidential nature which is disclosed by Test Company, or otherwise acquired by the Participant, in the course of today's study. By way of illustration, but not limitation, Confidential Information includes trade secrets, processes, formulae, data, know-how, products, designs, drawings, computer aided design files and other computer files, computer software, ideas, improvements, inventions, training methods and materials, marketing techniques, plans, strategies, budgets, financial information, or forecasts. Any information the Participant acquires relating to this product during this study is confidential and proprietary to Test Company and is being disclosed solely for the purposes of the Participant's participation in today's usability study. By signing this form the Participant acknowledges that s/he will receive monetary compensation for feedback and will not disclose this confidential information obtained today to anyone else or any other organizations. Participant's printed name: ___________________________________________________ Signature: __________________________________________________________________
Informed Consent Test Company would like to thank you for participating in this study. The purpose of this study is to evaluate an electronic health records system. If you decide to participate, you will be asked to perform several tasks using the prototype and give your feedback. The study will last about 30 minutes. At the conclusion of the test, you will be compensated for your time. Agreement I understand and agree that as a voluntary participant in the present study conducted by Test Company I am free to withdraw consent or discontinue participation at any time. I understand and agree to participate in the study conducted and videotaped by the Test Company. I understand and consent to the use and release of the videotape by Test Company. I understand that the information and videotape is for research purposes only and that my name and image will not be used for any purpose other than research. I relinquish any rights to the videotape and understand the videotape may be copied and used by Test Company without further permission. I understand and agree that the purpose of this study is to make software applications more useful and usable in the future. I understand and agree that the data collected from this study may be shared with outside of Test Company and Test Company's client. I understand and agree that data confidentiality is assured, because only de- identified data - i.e., identification numbers not names - will be used in analysis and reporting of the results. I agree to immediately raise any concerns or areas of discomfort with the study administrator. I understand that I can leave at any time. Please check one of the following: □ YES, I have read the above statement and agree to be a participant. □ NO, I choose not to participate in this study. Signature: _________________________________ Date: _______________________
Only four tasks are presented here for illustration. EHRUT Usability Test Moderator's Guide Administrator _____________________
Data Logger _____________________
Date _________________ Time _____________________
Participant # _________
Location _____________________
Prior to testing
■ Confirm schedule with Participants ■ Ensure EHRUT lab environment is running properly ■ Ensure Consent forms are complete for all participants ■ Ensure lab and data recording equipment is running properly
Prior to each participant: ■ Reset application ■ Restore application to base state using script restoredb.bat ■ Start session recordings with GTM Recording
Prior to each task: ■ Reset application to starting point for next task
After each participant: ■ End session recordings with tool ■ Fill out all paper work and acknowledgement form.
After all testing ■ Scan all forms and shred originals ■ Back up all video and data files
Orientation (5 minutes) Thank you for participating in this study. Our session today will last 2 hours today. During that time you will take a look at an electronic health record system. I will ask you to complete a few tasks using this system and answer some questions. We are interested in how easy (or how difficult) this system is to use, what in it would be useful to you, and how we could improve it. You will be asked to complete these tasks on your own trying to do them as quickly as possible with the fewest possible errors or deviations. Do not do anything more than asked. If you get lost or have difficulty I cannot answer help you with anything to do with the system itself. Please save your detailed comments until the end of a task or the end of the session as a whole when we can discuss freely. I did not have any involvement in its creation, so please be honest with your opinions. The product you will be using today is describe the state of the application, i.e., production version, early prototype, etc. Some of the data may not make sense as it is placeholder data. We are recording the audio and screenshots of our session today. All of the information that you provide will be kept confidential and your name will not be associated with your comments at any time. Do you have any questions or concerns? Preliminary Questions (5 minutes) What is your job title / appointment? How long have you been working in this role? What are some of your main responsibilities? Tell me about your experience with electronic health records.
Preview: First Impressions (6 Minutes) This is the application you will be working with. Have you heard of it? Yes ___ No ___ If so, tell me what you know about it. Show test participant the EHRUT. Please don't click on anything just yet. What do you notice? What are you able to do here? Please be specific. Notes / Comments:
Task 1: Create an Order – Ed Wood (5 Minutes) Take the participant to the starting point for the task. - FNC The patient you are examining 5’ 10” 285 lbs. male needs a differential diagnosis of 034.0 Streptococcal Sore Throat and needs a 87880 rapid strep to confirm diagnosis. Enter Vitals, Dx and SP into the system Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, enter 5 feet 10 inches and 285 lbs 2. go to the DX tab and Enter the diagnosis 034.0 Streptococcal Sore Throat 3. Note Alert for Obesity and Hypertension in CDS slider 4. Still inside FNC, go to the SP tab 5. Enter procedure code 87880 Strep A Assay 6. Still inside FNC, click the Close button to close the note, save the note as incomplete 7. Click okay.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 2: Utilize an existing Clinical Decision Support Alert – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You run are in consultation with a patient and his parent who is 71 years old. You want to quickly see if there are any Clinical Support Alerts for the parent. Go to the Appointment to review CDS Alerts and look at the source information for the alert. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
Open Patient Norman Wood
Open Update Appointment from Envelope
Open Clinical Decision Support Tab
Note Fall Risk Rule on Slider
Click on the Hyperlink for Fall Risk Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 3: Creation of a Procedure Task Message to the Nurses - Ed Wood (5 Minutes) Take the participant to the starting point for the task. - FNC
A patient you saw earlier that requested an order for a test at a different lab wants the lab found it was not covered by his insurance. He wants it to be performed in your office. You need to order a rapid strep test (87880) for the patient, as he is on his way back into the office.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open the scheduler 2. Find the appointment for Ed Wood 3. Click the Blue Folder (Open/Create note) 4. Click New->Procedure Task Message
a. Enter the Nurses b. Click Okay
5. Click to close the note a. Click Okay
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 4: Approve a Lab result (5 Minutes) Take the participant to the starting point for the task. - DESKTOP
You have a lab result request message in your inbox to process. You need to review and approve the request.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations Approval of Lab Results
1. Locate the Lab Result Approval message in the Desktop Message pane 2. Click on the Time and Date Hyperlink or Plus (+) sign next to the message 3. Click on Process Message 4. From the Modify Message window 5. After review of the results, click the Approved All button
a. Your user (provider) name will auto populate along with the current date 6. Click Complete
a. This will simultaneously set the approved lab results and complete the message Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 5: Document Drug Allergy in History – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are examining reports to you that she has been taking no meds because she has an anaphylactic reaction to Penicillins. Please document the allergy in History Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Find Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Click Drug Allergy
6. In the Allergen column, select Penicillins.
7. In the Reaction column, select anaphylaxis.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 6: Drug Allergy Alert in Rx Interaction – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP Need to prescribe Keflex to Mary Woods chart 1 tablet per day by mouth for 10 days Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Click Rx Tab
6. In the Drug field, enter Keflex
7. Click the find control
8. Select Keflex 500 mg
9. Pop up: Receive Drug Screening Warning: ALLERGY ALERT: The use of Keflex cross-sensitivity reaction based on a reported history of allergy to PENICILLINS. Do you want to continue? Click Yes
Comments: Observed Errors and Verbalizations: Comments: Rating: Overall, this task was: ___________ Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 7: Drug Drug Interaction – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP An agitated patient wants you to prescribe Prozac immediately. 20mg 1 time per day by mouth. Please prescribe the medication. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Find Mary Wood that has an appointment scheduled.
2. Click the Open/Create Note icon
3. FNC
4. Click Rx Tab
5. In the Drug field, enter Prozac
6. Click the find control
7. Select Prozac 20mg tablet
8. Pop up: Receive Drug Screening Warning: Duplicate Therapy: The use of Prozac is a duplicate therapy with Zoloft 50 mg. Do you want to continue?
a. Click No
9. Print -> Save and print Button
a. Print Dialog
10. Click ok to save and exit the note
Comments: Observed Errors and Verbalizations: Comments: Rating: Overall, this task was: ___________ Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 8: Medication List in OPS – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You are about to walk into an exam room for a med check on a patient. Go to One Page Summary and review the patient’s drug list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Go to Patient Demographics 2. Click Patient 3. Click One Page Summary 4. Click hyperlink in index for Current Medication 5. Verify the data is displayed correctly
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 9: Medication List in Hx Tab with Filter – Mary Wood (5 Minutes)
Take the participant to the starting point for the task. - DESKTOP
Previously very ill patient with a very large medication history is asking about her current medications. You want to compare the active/inactive medications with the maintenance medication list (which are two different filters in the system Go to Hx Tab and change the filter to show only Active Medications and them maintenance medications.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, go to the HX tab 2. Click on the Medication History 3. Review the items on the list 4. Click the search icon to change the filter 5. Change the filter to maintenance 6. Review the Maintenance Medications
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 10: Rx Refill Complete (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You have a few minutes to complete your drug refill request messages Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Messages
2. Locate message
3. Click on patient’s blue envelope.
4. Select Process Rx Refill
5. Medication History screen
6. Select the drug by clicking the Refill button.
7. Sig Writer screen
a. Verify information in sig
8. Click Ok
a. Return to the Modify Message screen
9. Click Complete.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 11: import Allergies from external list - Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are seeing has a C-CDA that needs to be checked against your record. Start with reconciling the Allergy list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open attachments 2. Go to attachments – Allergies - CCD 3. Click the import allergies icon 4. Sulfasalazine -> Add 5. Penicillin V -> Merge/Add 6. Carbamazepine -> ignore/remove 7. Click Reconcile 8. Go to Hx
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 12: Import Medications from external list – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are seeing has a C-CDA that needs to be checked against your record. Start with reconciling the Medication list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open attachments 2. View the medication CCD 3. Click the import medications icon 4. Simvastatin -> Add 5. Lorazepam -> Add 6. Lisinopril -> Add/Merge 7. Click reconcile 8. Go to patient Hx – Medications
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 13: Verify import in Allergy list and Medication List – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP Please validate that the import of Allergy list and Medication list import has the expected information Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Find Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Note the CDS rule for the combination of the new allergy and medication
6. Click Drug Allergy
a. Verify the information is correct from the import
7. Click on the Medication History
a. Verify the information is correct from the import
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Final Questions (10 Minutes) What was your overall impression of this system? What aspects of the system did you like most? What aspects of the system did you like least? Were there any features that you were surprised to see? What features did you expect to encounter but did not see? That is, is there anything that is missing in this application? Compare this system to other systems you have used. Would you recommend this system to your colleagues? Administer the SUS
Appendix 6: INCENTIVE RECEIPT AND ACKNOWLEDGMENT FORM
Acknowledgement of Receipt I hereby acknowledge receipt of $ _____ for my participation in a research study run by Aprima Medical Software. Printed Name: _____________________________________________________________ Address: __________________________________________________________________ __________________________________________________________________________ Signature: _______________________________________________ Date: ____________ Usability Researcher: ________________________________________________________ Signature of Usability Researcher: ____________________________ Date: ______________ Witness: ___________________________________________________________________ Witness Signature: ________________________________________ Date: ______________
Report based on ISO/IEC 25062:2006 Common Industry Format for Usability Test Reports
Aprima 2014 Date of Usability Test: 05/21/13-05/23/13 Date of Report: 05/27/13 Report Prepared By: Aprima Medical Software Project Management Cornell Hardman (214) 466-8107 Aprima Medical Software 3330 Keller Springs Road Suite 201 Carrollton, TX 75006
Table of Contents EXECUTIVE SUMMARY ................................................................................................................. 3
Major findings ............................................................................................................................... 5
Areas for improvement ................................................................................................................. 5
the participant schedule, and included each participant's demographic
characteristics as provided by the recruiting firm.
STUDY DESIGN
Overall, the objective of this test was to uncover areas where the application
performed well - that is, effectively, efficiently, and with satisfaction - and areas
where the application failed to meet the needs of the participants. The data
from this test may serve as a baseline for future tests with an updated version
of the same EHR and/or comparison with other EHRs provided the same tasks
are used. In short, this testing serves as both a means to record or benchmark
current usability, but also to identify areas where improvements must be made.
During the usability test, participants interacted with a single EHR. Each
participant used the system in the same location, and was provided with the
same instructions. The system was evaluated for effectiveness, efficiency and
satisfaction as defined by measures collected and analyzed for each
participant:
Number of tasks successfully completed within the allotted time without assistance
Time to complete the tasks Number and types of errors Path deviations Participant's verbalizations (comments) Participant's satisfaction ratings of the system
Additional information about the various measures can be found in
have successfully completed the task. I would like to request that you
not talk aloud or verbalize while you are doing the tasks. I will ask you
your impressions about the task once you are done.
Participants were then given 13 tasks to complete. Tasks are listed in the
moderator's guide in the Appendix.
USABILITY METRICS
According to the NIST Guide to the Processes Approach for Improving the
Usability of Electronic Health Records, EHRs should support a process that
provides a high level of usability for all users. The goal is for users to interact
with the system effectively, efficiently, and with an acceptable level of
satisfaction. To this end, metrics for effectiveness, efficiency and user
satisfaction were captured during the usability testing. The goals of the test
were to assess:
1. Effectiveness of EHRUT by measuring participant success rates and errors
2. Efficiency of EHRUT by measuring the average task time and path
deviations
3. Satisfaction with EHRUT by measuring ease of use ratings
DATA SCORING
The following table (Table 1) details how tasks were scored, errors evaluated,
and the time data analyzed.
Measures Rational and Scoring
Effectiveness: Task Success
A task was counted as a "Success" if the participant was able to achieve the correct outcome, without assistance, within the time allotted on a per task basis. The total number of successes were calculated for each task and then divided by the total number of times that task was attempted. The results are provided as a percentage.
Task times were recorded for successes. Observed task times divided by the optimal time for each task is a measure of optimal efficiency. Optimal task performance time, as benchmarked by expert performance under realistic conditions, is recorded when constructing tasks. Target task times used for task times in the Moderator's Guide must be operationally defined by taking multiple measures of optimal performance and multiplying by some factor that allows some time buffer because the participants are presumably not trained to expert performance. Scoring used a factor of 2. Thus, if expert, optimal performance on a task was 80 seconds then allotted task time performance was 80 * 2 = 160 seconds. This ratio should be aggregated across tasks and reported with mean and variance scores.
Effectiveness: Task Failures
If the participant abandoned the task, did not reach the correct answer or performed it incorrectly, or reached the end of the allotted time before successful completion, the task was counted as a "Failure." No task times were taken for errors. The total number of errors was calculated for each task and then divided by the total number of times that task was attempted. Not all deviations would be counted as errors. This should also be expressed as the mean number of failed tasks per participant. On a qualitative level, an enumeration of errors and error types were collected.
Efficiency: Task Deviations
The participant's path (i.e., steps) through the application was recorded. Deviations occur if the participant, for example, went to a wrong screen, clicked on an incorrect menu item, followed an incorrect link, or interacted incorrectly with an on-screen control. This path was compared to the optimal path. The number of steps in the observed path is divided by the number of optimal steps in order to provide a ratio of path deviation. It is strongly recommended that task deviations be reported. Optimal paths (i.e., procedural steps) should be recorded when constructing tasks.
Efficiency: Task Time
Each task was timed from when the administrator said "Begin" until the participant said, "Done." If he or she failed to say "Done," the time was stopped when the participant stopped performing the task. Only task times for tasks that were successfully completed were included in the average task time analysis. Average time per task was calculated for each task. Variance measures (standard deviation and standard error) were also calculated.
Satisfaction: Participant's subjective impression of the ease of use of the
Task Rating application was measured by administering both a simple post-task question as well as a post-session questionnaire. After each task, the participant was asked to rate "Overall, this task was:" on a scale of 1 (Very Difficult) to 5 (Very Easy). These data are averaged across participants. Common convention is that average ratings for systems judged easy to use should be 3.3 or above. To measure participants' confidence in and likeability of the EHRUT overall, the testing team administered the System Usability Scale (SUS) post-test questionnaire. Questions included, "I think I would like to use this system frequently," "I thought the system was easy to use," and "I would imagine that most people would learn to use this system very quickly." See full System Usability Score questionnaire in Appendix 5.
Table 1. Details of how observed data were scored.
The purpose of a screener to ensure that the participants selected represent
the target user population as closely as possible. (Portions of this sample
screener are taken from www.usability.gov/templates/index.html#Usability and
adapted for use.)
Recruiting Script for Recruiting Firm
Hello, my name is _______________, calling from [Insert name of recruiting
firm]. We are recruiting individuals to participate in a usability study for an
electronic health record. We would like to ask you a few questions to see if
you qualify and if would like to participate. This should only take a few minutes
of your time. This is strictly for research purposes. If you are interested and
qualify for the study, you will be paid to participate. Can I ask you a few
questions?
Customize this by dropping or adding questions so that it reflects your EHR's
primary audience
1. [If not obvious] Are you male or female? [Recruit a mix of participants]
2. Have you participated in a focus group or usability test in the past xx months? [If yes, Terminate]
3. Do you, or does anyone in your home, work in marketing research, usability research, web design [If yes, Terminate]
4. Do you, or does anyone in your home, have a commercial or research interest in an electronic health record software or consulting company? [If yes, Terminate]
5. Which of the following best describes your age? [23 to 39; 40 to 59; 60 and older] [Recruit Mix]
6. Which of the following best describes your race or ethnic group? [e.g., Caucasian, Asian, Black/African-American, Latino/a or Hispanic, etc.]
7. Do you require any assistive technologies to use a computer? [if so, please describe] Professional Demographics Customize this to reflect your EHR's primary audience
8. What is your current position and title? (Must be healthcare provider)
□ RN: Specialty _______________________
□ Physician: Specialty _______________________
□ Resident: Specialty _______________________
□ Medical Assistant _______________________
□ Administrative Staff
□ Other [Terminate]
9. How long have you held this position?
10. Describe your work location (or affiliation) and environment? (Recruit according to the intended users of the application. e.g., private practice, health system, government clinic, etc.)
11. Which of the following describes your highest level of education? [e.g., high school graduate/GED, some college, college graduate (RN, BSN), postgraduate (MD/PhD), other (explain)
12. Besides reading email, what professional activities do you do on the computer? [e.g., access EHR, research; reading news; shopping/banking; digital pictures; programming/word processing, etc.] [If no computer use at all, Terminate]
13. About how many hours per week do you spend on the computer? [Recruit according to the demographics of the intended users, e.g., 0 to 10, 11 to 25, 26+ hours per week]
14. What computer platform do you usually use? [e.g., Mac, Windows, etc.]
15. What Internet browser(s) do you usually use? [e.g., Firefox, IE, AOL, etc.]
16. In the last month, how often have you used an electronic health record?
17. How many years have you used an electronic health record?
18. How many EHRs do you use or are you familiar with?
19. How does your work environment handle patient records? [Recruit according to the demographics of the intended users]
Appendix 3: NON-DISCLOSURE AGREEMENT AND INFORMED CONSENT FORM
Non-Disclosure Agreement THIS AGREEMENT is entered into as of _________________, 2013, between ________________ ("the Participant") and the testing organization Aprima Medical Software located at 3330 Keller Springs Rd. Suite 201, Carrollton, TX 75006. The Participant acknowledges his or her voluntary participation in today's usability study may bring the Participant into possession of Confidential Information. The term "Confidential Information" means all technical and commercial information of a proprietary or confidential nature which is disclosed by Test Company, or otherwise acquired by the Participant, in the course of today's study. By way of illustration, but not limitation, Confidential Information includes trade secrets, processes, formulae, data, know-how, products, designs, drawings, computer aided design files and other computer files, computer software, ideas, improvements, inventions, training methods and materials, marketing techniques, plans, strategies, budgets, financial information, or forecasts. Any information the Participant acquires relating to this product during this study is confidential and proprietary to Test Company and is being disclosed solely for the purposes of the Participant's participation in today's usability study. By signing this form the Participant acknowledges that s/he will receive monetary compensation for feedback and will not disclose this confidential information obtained today to anyone else or any other organizations. Participant's printed name: ___________________________________________________ Signature: __________________________________________________________________
Informed Consent Test Company would like to thank you for participating in this study. The purpose of this study is to evaluate an electronic health records system. If you decide to participate, you will be asked to perform several tasks using the prototype and give your feedback. The study will last about 30 minutes. At the conclusion of the test, you will be compensated for your time. Agreement I understand and agree that as a voluntary participant in the present study conducted by Test Company I am free to withdraw consent or discontinue participation at any time. I understand and agree to participate in the study conducted and videotaped by the Test Company. I understand and consent to the use and release of the videotape by Test Company. I understand that the information and videotape is for research purposes only and that my name and image will not be used for any purpose other than research. I relinquish any rights to the videotape and understand the videotape may be copied and used by Test Company without further permission. I understand and agree that the purpose of this study is to make software applications more useful and usable in the future. I understand and agree that the data collected from this study may be shared with outside of Test Company and Test Company's client. I understand and agree that data confidentiality is assured, because only de- identified data - i.e., identification numbers not names - will be used in analysis and reporting of the results. I agree to immediately raise any concerns or areas of discomfort with the study administrator. I understand that I can leave at any time. Please check one of the following: □ YES, I have read the above statement and agree to be a participant. □ NO, I choose not to participate in this study. Signature: _________________________________ Date: _______________________
Only four tasks are presented here for illustration. EHRUT Usability Test Moderator's Guide Administrator _____________________
Data Logger _____________________
Date _________________ Time _____________________
Participant # _________
Location _____________________
Prior to testing
■ Confirm schedule with Participants ■ Ensure EHRUT lab environment is running properly ■ Ensure Consent forms are complete for all participants ■ Ensure lab and data recording equipment is running properly
Prior to each participant: ■ Reset application ■ Restore application to base state using script restoredb.bat ■ Start session recordings with GTM Recording
Prior to each task: ■ Reset application to starting point for next task
After each participant: ■ End session recordings with tool ■ Fill out all paper work and acknowledgement form.
After all testing ■ Scan all forms and shred originals ■ Back up all video and data files
Orientation (5 minutes) Thank you for participating in this study. Our session today will last 2 hours today. During that time you will take a look at an electronic health record system. I will ask you to complete a few tasks using this system and answer some questions. We are interested in how easy (or how difficult) this system is to use, what in it would be useful to you, and how we could improve it. You will be asked to complete these tasks on your own trying to do them as quickly as possible with the fewest possible errors or deviations. Do not do anything more than asked. If you get lost or have difficulty I cannot answer help you with anything to do with the system itself. Please save your detailed comments until the end of a task or the end of the session as a whole when we can discuss freely. I did not have any involvement in its creation, so please be honest with your opinions. The product you will be using today is describe the state of the application, i.e., production version, early prototype, etc. Some of the data may not make sense as it is placeholder data. We are recording the audio and screenshots of our session today. All of the information that you provide will be kept confidential and your name will not be associated with your comments at any time. Do you have any questions or concerns? Preliminary Questions (5 minutes) What is your job title / appointment? How long have you been working in this role? What are some of your main responsibilities? Tell me about your experience with electronic health records.
Preview: First Impressions (6 Minutes) This is the application you will be working with. Have you heard of it? Yes ___ No ___ If so, tell me what you know about it. Show test participant the EHRUT. Please don't click on anything just yet. What do you notice? What are you able to do here? Please be specific. Notes / Comments:
Task 1: Create an Order – Ed Wood (5 Minutes) Take the participant to the starting point for the task. - FNC The patient you are examining 5’ 10” 285 lbs. male needs a differential diagnosis of 034.0 Streptococcal Sore Throat and needs a 87880 rapid strep to confirm diagnosis. Enter Vitals, Dx and SP into the system Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, enter 5 feet 10 inches and 285 lbs 2. go to the DX tab and Enter the diagnosis 034.0 Streptococcal Sore Throat 3. Note Alert for Obesity and Hypertension in CDS slider 4. Still inside FNC, go to the SP tab 5. Enter procedure code 87880 Strep A Assay 6. Still inside FNC, click the Close button to close the note, save the note as incomplete 7. Click okay.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 2: Utilize an existing Clinical Decision Support Alert – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You run are in consultation with a patient and his parent who is 71 years old. You want to quickly see if there are any Clinical Support Alerts for the parent. Go to the Appointment to review CDS Alerts and look at the source information for the alert. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
Open Patient Norman Wood
Open Update Appointment from Envelope
Open Clinical Decision Support Tab
Note Fall Risk Rule on Slider
Click on the Hyperlink for Fall Risk Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 3: Creation of a Procedure Task Message to the Nurses - Ed Wood (5 Minutes) Take the participant to the starting point for the task. - FNC
A patient you saw earlier that requested an order for a test at a different lab wants the lab found it was not covered by his insurance. He wants it to be performed in your office. You need to order a rapid strep test (87880) for the patient, as he is on his way back into the office.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open the scheduler 2. Find the appointment for Ed Wood 3. Click the Blue Folder (Open/Create note) 4. Click New->Procedure Task Message
a. Enter the Nurses b. Click Okay
5. Click to close the note a. Click Okay
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 4: Approve a Lab result (5 Minutes) Take the participant to the starting point for the task. - DESKTOP
You have a lab result request message in your inbox to process. You need to review and approve the request.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations Approval of Lab Results
1. Locate the Lab Result Approval message in the Desktop Message pane 2. Click on the Time and Date Hyperlink or Plus (+) sign next to the message 3. Click on Process Message 4. From the Modify Message window 5. After review of the results, click the Approved All button
a. Your user (provider) name will auto populate along with the current date 6. Click Complete
a. This will simultaneously set the approved lab results and complete the message Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 5: Document Drug Allergy in History – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are examining reports to you that she has been taking no meds because she has an anaphylactic reaction to Penicillins. Please document the allergy in History Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Find Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Click Drug Allergy
6. In the Allergen column, select Penicillins.
7. In the Reaction column, select anaphylaxis.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 6: Drug Allergy Alert in Rx Interaction – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP Need to prescribe Keflex to Mary Woods chart 1 tablet per day by mouth for 10 days Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Click Rx Tab
6. In the Drug field, enter Keflex
7. Click the find control
8. Select Keflex 500 mg
9. Pop up: Receive Drug Screening Warning: ALLERGY ALERT: The use of Keflex cross-sensitivity reaction based on a reported history of allergy to PENICILLINS. Do you want to continue? Click Yes
Comments: Observed Errors and Verbalizations: Comments: Rating: Overall, this task was: ___________ Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 7: Drug Drug Interaction – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP An agitated patient wants you to prescribe Prozac immediately. 20mg 1 time per day by mouth. Please prescribe the medication. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Find Mary Wood that has an appointment scheduled.
2. Click the Open/Create Note icon
3. FNC
4. Click Rx Tab
5. In the Drug field, enter Prozac
6. Click the find control
7. Select Prozac 20mg tablet
8. Pop up: Receive Drug Screening Warning: Duplicate Therapy: The use of Prozac is a duplicate therapy with Zoloft 50 mg. Do you want to continue?
a. Click No
9. Print -> Save and print Button
a. Print Dialog
10. Click ok to save and exit the note
Comments: Observed Errors and Verbalizations: Comments: Rating: Overall, this task was: ___________ Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 8: Medication List in OPS – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You are about to walk into an exam room for a med check on a patient. Go to One Page Summary and review the patient’s drug list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Go to Patient Demographics 2. Click Patient 3. Click One Page Summary 4. Click hyperlink in index for Current Medication 5. Verify the data is displayed correctly
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 9: Medication List in Hx Tab with Filter – Mary Wood (5 Minutes)
Take the participant to the starting point for the task. - DESKTOP
Previously very ill patient with a very large medication history is asking about her current medications. You want to compare the active/inactive medications with the maintenance medication list (which are two different filters in the system Go to Hx Tab and change the filter to show only Active Medications and them maintenance medications.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, go to the HX tab 2. Click on the Medication History 3. Review the items on the list 4. Click the search icon to change the filter 5. Change the filter to maintenance 6. Review the Maintenance Medications
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 10: Rx Refill Complete (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You have a few minutes to complete your drug refill request messages Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Messages
2. Locate message
3. Click on patient’s blue envelope.
4. Select Process Rx Refill
5. Medication History screen
6. Select the drug by clicking the Refill button.
7. Sig Writer screen
a. Verify information in sig
8. Click Ok
a. Return to the Modify Message screen
9. Click Complete.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 11: import Allergies from external list - Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are seeing has a C-CDA that needs to be checked against your record. Start with reconciling the Allergy list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open attachments 2. Go to attachments – Allergies - CCD 3. Click the import allergies icon 4. Sulfasalazine -> Add 5. Penicillin V -> Merge/Add 6. Carbamazepine -> ignore/remove 7. Click Reconcile 8. Go to Hx
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 12: Import Medications from external list – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are seeing has a C-CDA that needs to be checked against your record. Start with reconciling the Medication list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open attachments 2. View the medication CCD 3. Click the import medications icon 4. Simvastatin -> Add 5. Lorazepam -> Add 6. Lisinopril -> Add/Merge 7. Click reconcile 8. Go to patient Hx – Medications
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 13: Verify import in Allergy list and Medication List – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP Please validate that the import of Allergy list and Medication list import has the expected information Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Find Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Note the CDS rule for the combination of the new allergy and medication
6. Click Drug Allergy
a. Verify the information is correct from the import
7. Click on the Medication History
a. Verify the information is correct from the import
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Final Questions (10 Minutes) What was your overall impression of this system? What aspects of the system did you like most? What aspects of the system did you like least? Were there any features that you were surprised to see? What features did you expect to encounter but did not see? That is, is there anything that is missing in this application? Compare this system to other systems you have used. Would you recommend this system to your colleagues? Administer the SUS
Appendix 6: INCENTIVE RECEIPT AND ACKNOWLEDGMENT FORM
Acknowledgement of Receipt I hereby acknowledge receipt of $ _____ for my participation in a research study run by Aprima Medical Software. Printed Name: _____________________________________________________________ Address: __________________________________________________________________ __________________________________________________________________________ Signature: _______________________________________________ Date: ____________ Usability Researcher: ________________________________________________________ Signature of Usability Researcher: ____________________________ Date: ______________ Witness: ___________________________________________________________________ Witness Signature: ________________________________________ Date: ______________
Report based on ISO/IEC 25062:2006 Common Industry Format for Usability Test Reports
Aprima 2014 Date of Usability Test: 05/21/13-05/23/13 Date of Report: 05/27/13 Report Prepared By: Aprima Medical Software Project Management Cornell Hardman (214) 466-8107 Aprima Medical Software 3330 Keller Springs Road Suite 201 Carrollton, TX 75006
Table of Contents EXECUTIVE SUMMARY ................................................................................................................. 3
Major findings ............................................................................................................................... 5
Areas for improvement ................................................................................................................. 5
the participant schedule, and included each participant's demographic
characteristics as provided by the recruiting firm.
STUDY DESIGN
Overall, the objective of this test was to uncover areas where the application
performed well - that is, effectively, efficiently, and with satisfaction - and areas
where the application failed to meet the needs of the participants. The data
from this test may serve as a baseline for future tests with an updated version
of the same EHR and/or comparison with other EHRs provided the same tasks
are used. In short, this testing serves as both a means to record or benchmark
current usability, but also to identify areas where improvements must be made.
During the usability test, participants interacted with a single EHR. Each
participant used the system in the same location, and was provided with the
same instructions. The system was evaluated for effectiveness, efficiency and
satisfaction as defined by measures collected and analyzed for each
participant:
Number of tasks successfully completed within the allotted time without assistance
Time to complete the tasks Number and types of errors Path deviations Participant's verbalizations (comments) Participant's satisfaction ratings of the system
Additional information about the various measures can be found in
have successfully completed the task. I would like to request that you
not talk aloud or verbalize while you are doing the tasks. I will ask you
your impressions about the task once you are done.
Participants were then given 13 tasks to complete. Tasks are listed in the
moderator's guide in the Appendix.
USABILITY METRICS
According to the NIST Guide to the Processes Approach for Improving the
Usability of Electronic Health Records, EHRs should support a process that
provides a high level of usability for all users. The goal is for users to interact
with the system effectively, efficiently, and with an acceptable level of
satisfaction. To this end, metrics for effectiveness, efficiency and user
satisfaction were captured during the usability testing. The goals of the test
were to assess:
1. Effectiveness of EHRUT by measuring participant success rates and errors
2. Efficiency of EHRUT by measuring the average task time and path
deviations
3. Satisfaction with EHRUT by measuring ease of use ratings
DATA SCORING
The following table (Table 1) details how tasks were scored, errors evaluated,
and the time data analyzed.
Measures Rational and Scoring
Effectiveness: Task Success
A task was counted as a "Success" if the participant was able to achieve the correct outcome, without assistance, within the time allotted on a per task basis. The total number of successes were calculated for each task and then divided by the total number of times that task was attempted. The results are provided as a percentage.
Task times were recorded for successes. Observed task times divided by the optimal time for each task is a measure of optimal efficiency. Optimal task performance time, as benchmarked by expert performance under realistic conditions, is recorded when constructing tasks. Target task times used for task times in the Moderator's Guide must be operationally defined by taking multiple measures of optimal performance and multiplying by some factor that allows some time buffer because the participants are presumably not trained to expert performance. Scoring used a factor of 2. Thus, if expert, optimal performance on a task was 80 seconds then allotted task time performance was 80 * 2 = 160 seconds. This ratio should be aggregated across tasks and reported with mean and variance scores.
Effectiveness: Task Failures
If the participant abandoned the task, did not reach the correct answer or performed it incorrectly, or reached the end of the allotted time before successful completion, the task was counted as a "Failure." No task times were taken for errors. The total number of errors was calculated for each task and then divided by the total number of times that task was attempted. Not all deviations would be counted as errors. This should also be expressed as the mean number of failed tasks per participant. On a qualitative level, an enumeration of errors and error types were collected.
Efficiency: Task Deviations
The participant's path (i.e., steps) through the application was recorded. Deviations occur if the participant, for example, went to a wrong screen, clicked on an incorrect menu item, followed an incorrect link, or interacted incorrectly with an on-screen control. This path was compared to the optimal path. The number of steps in the observed path is divided by the number of optimal steps in order to provide a ratio of path deviation. It is strongly recommended that task deviations be reported. Optimal paths (i.e., procedural steps) should be recorded when constructing tasks.
Efficiency: Task Time
Each task was timed from when the administrator said "Begin" until the participant said, "Done." If he or she failed to say "Done," the time was stopped when the participant stopped performing the task. Only task times for tasks that were successfully completed were included in the average task time analysis. Average time per task was calculated for each task. Variance measures (standard deviation and standard error) were also calculated.
Satisfaction: Participant's subjective impression of the ease of use of the
Task Rating application was measured by administering both a simple post-task question as well as a post-session questionnaire. After each task, the participant was asked to rate "Overall, this task was:" on a scale of 1 (Very Difficult) to 5 (Very Easy). These data are averaged across participants. Common convention is that average ratings for systems judged easy to use should be 3.3 or above. To measure participants' confidence in and likeability of the EHRUT overall, the testing team administered the System Usability Scale (SUS) post-test questionnaire. Questions included, "I think I would like to use this system frequently," "I thought the system was easy to use," and "I would imagine that most people would learn to use this system very quickly." See full System Usability Score questionnaire in Appendix 5.
Table 1. Details of how observed data were scored.
The purpose of a screener to ensure that the participants selected represent
the target user population as closely as possible. (Portions of this sample
screener are taken from www.usability.gov/templates/index.html#Usability and
adapted for use.)
Recruiting Script for Recruiting Firm
Hello, my name is _______________, calling from [Insert name of recruiting
firm]. We are recruiting individuals to participate in a usability study for an
electronic health record. We would like to ask you a few questions to see if
you qualify and if would like to participate. This should only take a few minutes
of your time. This is strictly for research purposes. If you are interested and
qualify for the study, you will be paid to participate. Can I ask you a few
questions?
Customize this by dropping or adding questions so that it reflects your EHR's
primary audience
1. [If not obvious] Are you male or female? [Recruit a mix of participants]
2. Have you participated in a focus group or usability test in the past xx months? [If yes, Terminate]
3. Do you, or does anyone in your home, work in marketing research, usability research, web design [If yes, Terminate]
4. Do you, or does anyone in your home, have a commercial or research interest in an electronic health record software or consulting company? [If yes, Terminate]
5. Which of the following best describes your age? [23 to 39; 40 to 59; 60 and older] [Recruit Mix]
6. Which of the following best describes your race or ethnic group? [e.g., Caucasian, Asian, Black/African-American, Latino/a or Hispanic, etc.]
7. Do you require any assistive technologies to use a computer? [if so, please describe] Professional Demographics Customize this to reflect your EHR's primary audience
8. What is your current position and title? (Must be healthcare provider)
□ RN: Specialty _______________________
□ Physician: Specialty _______________________
□ Resident: Specialty _______________________
□ Medical Assistant _______________________
□ Administrative Staff
□ Other [Terminate]
9. How long have you held this position?
10. Describe your work location (or affiliation) and environment? (Recruit according to the intended users of the application. e.g., private practice, health system, government clinic, etc.)
11. Which of the following describes your highest level of education? [e.g., high school graduate/GED, some college, college graduate (RN, BSN), postgraduate (MD/PhD), other (explain)
12. Besides reading email, what professional activities do you do on the computer? [e.g., access EHR, research; reading news; shopping/banking; digital pictures; programming/word processing, etc.] [If no computer use at all, Terminate]
13. About how many hours per week do you spend on the computer? [Recruit according to the demographics of the intended users, e.g., 0 to 10, 11 to 25, 26+ hours per week]
14. What computer platform do you usually use? [e.g., Mac, Windows, etc.]
15. What Internet browser(s) do you usually use? [e.g., Firefox, IE, AOL, etc.]
16. In the last month, how often have you used an electronic health record?
17. How many years have you used an electronic health record?
18. How many EHRs do you use or are you familiar with?
19. How does your work environment handle patient records? [Recruit according to the demographics of the intended users]
Appendix 3: NON-DISCLOSURE AGREEMENT AND INFORMED CONSENT FORM
Non-Disclosure Agreement THIS AGREEMENT is entered into as of _________________, 2013, between ________________ ("the Participant") and the testing organization Aprima Medical Software located at 3330 Keller Springs Rd. Suite 201, Carrollton, TX 75006. The Participant acknowledges his or her voluntary participation in today's usability study may bring the Participant into possession of Confidential Information. The term "Confidential Information" means all technical and commercial information of a proprietary or confidential nature which is disclosed by Test Company, or otherwise acquired by the Participant, in the course of today's study. By way of illustration, but not limitation, Confidential Information includes trade secrets, processes, formulae, data, know-how, products, designs, drawings, computer aided design files and other computer files, computer software, ideas, improvements, inventions, training methods and materials, marketing techniques, plans, strategies, budgets, financial information, or forecasts. Any information the Participant acquires relating to this product during this study is confidential and proprietary to Test Company and is being disclosed solely for the purposes of the Participant's participation in today's usability study. By signing this form the Participant acknowledges that s/he will receive monetary compensation for feedback and will not disclose this confidential information obtained today to anyone else or any other organizations. Participant's printed name: ___________________________________________________ Signature: __________________________________________________________________
Informed Consent Test Company would like to thank you for participating in this study. The purpose of this study is to evaluate an electronic health records system. If you decide to participate, you will be asked to perform several tasks using the prototype and give your feedback. The study will last about 30 minutes. At the conclusion of the test, you will be compensated for your time. Agreement I understand and agree that as a voluntary participant in the present study conducted by Test Company I am free to withdraw consent or discontinue participation at any time. I understand and agree to participate in the study conducted and videotaped by the Test Company. I understand and consent to the use and release of the videotape by Test Company. I understand that the information and videotape is for research purposes only and that my name and image will not be used for any purpose other than research. I relinquish any rights to the videotape and understand the videotape may be copied and used by Test Company without further permission. I understand and agree that the purpose of this study is to make software applications more useful and usable in the future. I understand and agree that the data collected from this study may be shared with outside of Test Company and Test Company's client. I understand and agree that data confidentiality is assured, because only de- identified data - i.e., identification numbers not names - will be used in analysis and reporting of the results. I agree to immediately raise any concerns or areas of discomfort with the study administrator. I understand that I can leave at any time. Please check one of the following: □ YES, I have read the above statement and agree to be a participant. □ NO, I choose not to participate in this study. Signature: _________________________________ Date: _______________________
Only four tasks are presented here for illustration. EHRUT Usability Test Moderator's Guide Administrator _____________________
Data Logger _____________________
Date _________________ Time _____________________
Participant # _________
Location _____________________
Prior to testing
■ Confirm schedule with Participants ■ Ensure EHRUT lab environment is running properly ■ Ensure Consent forms are complete for all participants ■ Ensure lab and data recording equipment is running properly
Prior to each participant: ■ Reset application ■ Restore application to base state using script restoredb.bat ■ Start session recordings with GTM Recording
Prior to each task: ■ Reset application to starting point for next task
After each participant: ■ End session recordings with tool ■ Fill out all paper work and acknowledgement form.
After all testing ■ Scan all forms and shred originals ■ Back up all video and data files
Orientation (5 minutes) Thank you for participating in this study. Our session today will last 2 hours today. During that time you will take a look at an electronic health record system. I will ask you to complete a few tasks using this system and answer some questions. We are interested in how easy (or how difficult) this system is to use, what in it would be useful to you, and how we could improve it. You will be asked to complete these tasks on your own trying to do them as quickly as possible with the fewest possible errors or deviations. Do not do anything more than asked. If you get lost or have difficulty I cannot answer help you with anything to do with the system itself. Please save your detailed comments until the end of a task or the end of the session as a whole when we can discuss freely. I did not have any involvement in its creation, so please be honest with your opinions. The product you will be using today is describe the state of the application, i.e., production version, early prototype, etc. Some of the data may not make sense as it is placeholder data. We are recording the audio and screenshots of our session today. All of the information that you provide will be kept confidential and your name will not be associated with your comments at any time. Do you have any questions or concerns? Preliminary Questions (5 minutes) What is your job title / appointment? How long have you been working in this role? What are some of your main responsibilities? Tell me about your experience with electronic health records.
Preview: First Impressions (6 Minutes) This is the application you will be working with. Have you heard of it? Yes ___ No ___ If so, tell me what you know about it. Show test participant the EHRUT. Please don't click on anything just yet. What do you notice? What are you able to do here? Please be specific. Notes / Comments:
Task 1: Create an Order – Ed Wood (5 Minutes) Take the participant to the starting point for the task. - FNC The patient you are examining 5’ 10” 285 lbs. male needs a differential diagnosis of 034.0 Streptococcal Sore Throat and needs a 87880 rapid strep to confirm diagnosis. Enter Vitals, Dx and SP into the system Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, enter 5 feet 10 inches and 285 lbs 2. go to the DX tab and Enter the diagnosis 034.0 Streptococcal Sore Throat 3. Note Alert for Obesity and Hypertension in CDS slider 4. Still inside FNC, go to the SP tab 5. Enter procedure code 87880 Strep A Assay 6. Still inside FNC, click the Close button to close the note, save the note as incomplete 7. Click okay.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 2: Utilize an existing Clinical Decision Support Alert – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You run are in consultation with a patient and his parent who is 71 years old. You want to quickly see if there are any Clinical Support Alerts for the parent. Go to the Appointment to review CDS Alerts and look at the source information for the alert. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
Open Patient Norman Wood
Open Update Appointment from Envelope
Open Clinical Decision Support Tab
Note Fall Risk Rule on Slider
Click on the Hyperlink for Fall Risk Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 3: Creation of a Procedure Task Message to the Nurses - Ed Wood (5 Minutes) Take the participant to the starting point for the task. - FNC
A patient you saw earlier that requested an order for a test at a different lab wants the lab found it was not covered by his insurance. He wants it to be performed in your office. You need to order a rapid strep test (87880) for the patient, as he is on his way back into the office.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open the scheduler 2. Find the appointment for Ed Wood 3. Click the Blue Folder (Open/Create note) 4. Click New->Procedure Task Message
a. Enter the Nurses b. Click Okay
5. Click to close the note a. Click Okay
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 4: Approve a Lab result (5 Minutes) Take the participant to the starting point for the task. - DESKTOP
You have a lab result request message in your inbox to process. You need to review and approve the request.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations Approval of Lab Results
1. Locate the Lab Result Approval message in the Desktop Message pane 2. Click on the Time and Date Hyperlink or Plus (+) sign next to the message 3. Click on Process Message 4. From the Modify Message window 5. After review of the results, click the Approved All button
a. Your user (provider) name will auto populate along with the current date 6. Click Complete
a. This will simultaneously set the approved lab results and complete the message Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 5: Document Drug Allergy in History – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are examining reports to you that she has been taking no meds because she has an anaphylactic reaction to Penicillins. Please document the allergy in History Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Find Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Click Drug Allergy
6. In the Allergen column, select Penicillins.
7. In the Reaction column, select anaphylaxis.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 6: Drug Allergy Alert in Rx Interaction – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP Need to prescribe Keflex to Mary Woods chart 1 tablet per day by mouth for 10 days Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Click Rx Tab
6. In the Drug field, enter Keflex
7. Click the find control
8. Select Keflex 500 mg
9. Pop up: Receive Drug Screening Warning: ALLERGY ALERT: The use of Keflex cross-sensitivity reaction based on a reported history of allergy to PENICILLINS. Do you want to continue? Click Yes
Comments: Observed Errors and Verbalizations: Comments: Rating: Overall, this task was: ___________ Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 7: Drug Drug Interaction – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP An agitated patient wants you to prescribe Prozac immediately. 20mg 1 time per day by mouth. Please prescribe the medication. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Find Mary Wood that has an appointment scheduled.
2. Click the Open/Create Note icon
3. FNC
4. Click Rx Tab
5. In the Drug field, enter Prozac
6. Click the find control
7. Select Prozac 20mg tablet
8. Pop up: Receive Drug Screening Warning: Duplicate Therapy: The use of Prozac is a duplicate therapy with Zoloft 50 mg. Do you want to continue?
a. Click No
9. Print -> Save and print Button
a. Print Dialog
10. Click ok to save and exit the note
Comments: Observed Errors and Verbalizations: Comments: Rating: Overall, this task was: ___________ Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 8: Medication List in OPS – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You are about to walk into an exam room for a med check on a patient. Go to One Page Summary and review the patient’s drug list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Go to Patient Demographics 2. Click Patient 3. Click One Page Summary 4. Click hyperlink in index for Current Medication 5. Verify the data is displayed correctly
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 9: Medication List in Hx Tab with Filter – Mary Wood (5 Minutes)
Take the participant to the starting point for the task. - DESKTOP
Previously very ill patient with a very large medication history is asking about her current medications. You want to compare the active/inactive medications with the maintenance medication list (which are two different filters in the system Go to Hx Tab and change the filter to show only Active Medications and them maintenance medications.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, go to the HX tab 2. Click on the Medication History 3. Review the items on the list 4. Click the search icon to change the filter 5. Change the filter to maintenance 6. Review the Maintenance Medications
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 10: Rx Refill Complete (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You have a few minutes to complete your drug refill request messages Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Messages
2. Locate message
3. Click on patient’s blue envelope.
4. Select Process Rx Refill
5. Medication History screen
6. Select the drug by clicking the Refill button.
7. Sig Writer screen
a. Verify information in sig
8. Click Ok
a. Return to the Modify Message screen
9. Click Complete.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 11: import Allergies from external list - Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are seeing has a C-CDA that needs to be checked against your record. Start with reconciling the Allergy list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open attachments 2. Go to attachments – Allergies - CCD 3. Click the import allergies icon 4. Sulfasalazine -> Add 5. Penicillin V -> Merge/Add 6. Carbamazepine -> ignore/remove 7. Click Reconcile 8. Go to Hx
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 12: Import Medications from external list – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are seeing has a C-CDA that needs to be checked against your record. Start with reconciling the Medication list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open attachments 2. View the medication CCD 3. Click the import medications icon 4. Simvastatin -> Add 5. Lorazepam -> Add 6. Lisinopril -> Add/Merge 7. Click reconcile 8. Go to patient Hx – Medications
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 13: Verify import in Allergy list and Medication List – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP Please validate that the import of Allergy list and Medication list import has the expected information Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Find Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Note the CDS rule for the combination of the new allergy and medication
6. Click Drug Allergy
a. Verify the information is correct from the import
7. Click on the Medication History
a. Verify the information is correct from the import
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Final Questions (10 Minutes) What was your overall impression of this system? What aspects of the system did you like most? What aspects of the system did you like least? Were there any features that you were surprised to see? What features did you expect to encounter but did not see? That is, is there anything that is missing in this application? Compare this system to other systems you have used. Would you recommend this system to your colleagues? Administer the SUS
Appendix 6: INCENTIVE RECEIPT AND ACKNOWLEDGMENT FORM
Acknowledgement of Receipt I hereby acknowledge receipt of $ _____ for my participation in a research study run by Aprima Medical Software. Printed Name: _____________________________________________________________ Address: __________________________________________________________________ __________________________________________________________________________ Signature: _______________________________________________ Date: ____________ Usability Researcher: ________________________________________________________ Signature of Usability Researcher: ____________________________ Date: ______________ Witness: ___________________________________________________________________ Witness Signature: ________________________________________ Date: ______________
Report based on ISO/IEC 25062:2006 Common Industry Format for Usability Test Reports
Aprima 2014 Date of Usability Test: 05/21/13-05/23/13 Date of Report: 05/27/13 Report Prepared By: Aprima Medical Software Project Management Cornell Hardman (214) 466-8107 Aprima Medical Software 3330 Keller Springs Road Suite 201 Carrollton, TX 75006
Table of Contents EXECUTIVE SUMMARY ................................................................................................................. 3
Major findings ............................................................................................................................... 5
Areas for improvement ................................................................................................................. 5
the participant schedule, and included each participant's demographic
characteristics as provided by the recruiting firm.
STUDY DESIGN
Overall, the objective of this test was to uncover areas where the application
performed well - that is, effectively, efficiently, and with satisfaction - and areas
where the application failed to meet the needs of the participants. The data
from this test may serve as a baseline for future tests with an updated version
of the same EHR and/or comparison with other EHRs provided the same tasks
are used. In short, this testing serves as both a means to record or benchmark
current usability, but also to identify areas where improvements must be made.
During the usability test, participants interacted with a single EHR. Each
participant used the system in the same location, and was provided with the
same instructions. The system was evaluated for effectiveness, efficiency and
satisfaction as defined by measures collected and analyzed for each
participant:
Number of tasks successfully completed within the allotted time without assistance
Time to complete the tasks Number and types of errors Path deviations Participant's verbalizations (comments) Participant's satisfaction ratings of the system
Additional information about the various measures can be found in
have successfully completed the task. I would like to request that you
not talk aloud or verbalize while you are doing the tasks. I will ask you
your impressions about the task once you are done.
Participants were then given 13 tasks to complete. Tasks are listed in the
moderator's guide in the Appendix.
USABILITY METRICS
According to the NIST Guide to the Processes Approach for Improving the
Usability of Electronic Health Records, EHRs should support a process that
provides a high level of usability for all users. The goal is for users to interact
with the system effectively, efficiently, and with an acceptable level of
satisfaction. To this end, metrics for effectiveness, efficiency and user
satisfaction were captured during the usability testing. The goals of the test
were to assess:
1. Effectiveness of EHRUT by measuring participant success rates and errors
2. Efficiency of EHRUT by measuring the average task time and path
deviations
3. Satisfaction with EHRUT by measuring ease of use ratings
DATA SCORING
The following table (Table 1) details how tasks were scored, errors evaluated,
and the time data analyzed.
Measures Rational and Scoring
Effectiveness: Task Success
A task was counted as a "Success" if the participant was able to achieve the correct outcome, without assistance, within the time allotted on a per task basis. The total number of successes were calculated for each task and then divided by the total number of times that task was attempted. The results are provided as a percentage.
Task times were recorded for successes. Observed task times divided by the optimal time for each task is a measure of optimal efficiency. Optimal task performance time, as benchmarked by expert performance under realistic conditions, is recorded when constructing tasks. Target task times used for task times in the Moderator's Guide must be operationally defined by taking multiple measures of optimal performance and multiplying by some factor that allows some time buffer because the participants are presumably not trained to expert performance. Scoring used a factor of 2. Thus, if expert, optimal performance on a task was 80 seconds then allotted task time performance was 80 * 2 = 160 seconds. This ratio should be aggregated across tasks and reported with mean and variance scores.
Effectiveness: Task Failures
If the participant abandoned the task, did not reach the correct answer or performed it incorrectly, or reached the end of the allotted time before successful completion, the task was counted as a "Failure." No task times were taken for errors. The total number of errors was calculated for each task and then divided by the total number of times that task was attempted. Not all deviations would be counted as errors. This should also be expressed as the mean number of failed tasks per participant. On a qualitative level, an enumeration of errors and error types were collected.
Efficiency: Task Deviations
The participant's path (i.e., steps) through the application was recorded. Deviations occur if the participant, for example, went to a wrong screen, clicked on an incorrect menu item, followed an incorrect link, or interacted incorrectly with an on-screen control. This path was compared to the optimal path. The number of steps in the observed path is divided by the number of optimal steps in order to provide a ratio of path deviation. It is strongly recommended that task deviations be reported. Optimal paths (i.e., procedural steps) should be recorded when constructing tasks.
Efficiency: Task Time
Each task was timed from when the administrator said "Begin" until the participant said, "Done." If he or she failed to say "Done," the time was stopped when the participant stopped performing the task. Only task times for tasks that were successfully completed were included in the average task time analysis. Average time per task was calculated for each task. Variance measures (standard deviation and standard error) were also calculated.
Satisfaction: Participant's subjective impression of the ease of use of the
Task Rating application was measured by administering both a simple post-task question as well as a post-session questionnaire. After each task, the participant was asked to rate "Overall, this task was:" on a scale of 1 (Very Difficult) to 5 (Very Easy). These data are averaged across participants. Common convention is that average ratings for systems judged easy to use should be 3.3 or above. To measure participants' confidence in and likeability of the EHRUT overall, the testing team administered the System Usability Scale (SUS) post-test questionnaire. Questions included, "I think I would like to use this system frequently," "I thought the system was easy to use," and "I would imagine that most people would learn to use this system very quickly." See full System Usability Score questionnaire in Appendix 5.
Table 1. Details of how observed data were scored.
The purpose of a screener to ensure that the participants selected represent
the target user population as closely as possible. (Portions of this sample
screener are taken from www.usability.gov/templates/index.html#Usability and
adapted for use.)
Recruiting Script for Recruiting Firm
Hello, my name is _______________, calling from [Insert name of recruiting
firm]. We are recruiting individuals to participate in a usability study for an
electronic health record. We would like to ask you a few questions to see if
you qualify and if would like to participate. This should only take a few minutes
of your time. This is strictly for research purposes. If you are interested and
qualify for the study, you will be paid to participate. Can I ask you a few
questions?
Customize this by dropping or adding questions so that it reflects your EHR's
primary audience
1. [If not obvious] Are you male or female? [Recruit a mix of participants]
2. Have you participated in a focus group or usability test in the past xx months? [If yes, Terminate]
3. Do you, or does anyone in your home, work in marketing research, usability research, web design [If yes, Terminate]
4. Do you, or does anyone in your home, have a commercial or research interest in an electronic health record software or consulting company? [If yes, Terminate]
5. Which of the following best describes your age? [23 to 39; 40 to 59; 60 and older] [Recruit Mix]
6. Which of the following best describes your race or ethnic group? [e.g., Caucasian, Asian, Black/African-American, Latino/a or Hispanic, etc.]
7. Do you require any assistive technologies to use a computer? [if so, please describe] Professional Demographics Customize this to reflect your EHR's primary audience
8. What is your current position and title? (Must be healthcare provider)
□ RN: Specialty _______________________
□ Physician: Specialty _______________________
□ Resident: Specialty _______________________
□ Medical Assistant _______________________
□ Administrative Staff
□ Other [Terminate]
9. How long have you held this position?
10. Describe your work location (or affiliation) and environment? (Recruit according to the intended users of the application. e.g., private practice, health system, government clinic, etc.)
11. Which of the following describes your highest level of education? [e.g., high school graduate/GED, some college, college graduate (RN, BSN), postgraduate (MD/PhD), other (explain)
12. Besides reading email, what professional activities do you do on the computer? [e.g., access EHR, research; reading news; shopping/banking; digital pictures; programming/word processing, etc.] [If no computer use at all, Terminate]
13. About how many hours per week do you spend on the computer? [Recruit according to the demographics of the intended users, e.g., 0 to 10, 11 to 25, 26+ hours per week]
14. What computer platform do you usually use? [e.g., Mac, Windows, etc.]
15. What Internet browser(s) do you usually use? [e.g., Firefox, IE, AOL, etc.]
16. In the last month, how often have you used an electronic health record?
17. How many years have you used an electronic health record?
18. How many EHRs do you use or are you familiar with?
19. How does your work environment handle patient records? [Recruit according to the demographics of the intended users]
Appendix 3: NON-DISCLOSURE AGREEMENT AND INFORMED CONSENT FORM
Non-Disclosure Agreement THIS AGREEMENT is entered into as of _________________, 2013, between ________________ ("the Participant") and the testing organization Aprima Medical Software located at 3330 Keller Springs Rd. Suite 201, Carrollton, TX 75006. The Participant acknowledges his or her voluntary participation in today's usability study may bring the Participant into possession of Confidential Information. The term "Confidential Information" means all technical and commercial information of a proprietary or confidential nature which is disclosed by Test Company, or otherwise acquired by the Participant, in the course of today's study. By way of illustration, but not limitation, Confidential Information includes trade secrets, processes, formulae, data, know-how, products, designs, drawings, computer aided design files and other computer files, computer software, ideas, improvements, inventions, training methods and materials, marketing techniques, plans, strategies, budgets, financial information, or forecasts. Any information the Participant acquires relating to this product during this study is confidential and proprietary to Test Company and is being disclosed solely for the purposes of the Participant's participation in today's usability study. By signing this form the Participant acknowledges that s/he will receive monetary compensation for feedback and will not disclose this confidential information obtained today to anyone else or any other organizations. Participant's printed name: ___________________________________________________ Signature: __________________________________________________________________
Informed Consent Test Company would like to thank you for participating in this study. The purpose of this study is to evaluate an electronic health records system. If you decide to participate, you will be asked to perform several tasks using the prototype and give your feedback. The study will last about 30 minutes. At the conclusion of the test, you will be compensated for your time. Agreement I understand and agree that as a voluntary participant in the present study conducted by Test Company I am free to withdraw consent or discontinue participation at any time. I understand and agree to participate in the study conducted and videotaped by the Test Company. I understand and consent to the use and release of the videotape by Test Company. I understand that the information and videotape is for research purposes only and that my name and image will not be used for any purpose other than research. I relinquish any rights to the videotape and understand the videotape may be copied and used by Test Company without further permission. I understand and agree that the purpose of this study is to make software applications more useful and usable in the future. I understand and agree that the data collected from this study may be shared with outside of Test Company and Test Company's client. I understand and agree that data confidentiality is assured, because only de- identified data - i.e., identification numbers not names - will be used in analysis and reporting of the results. I agree to immediately raise any concerns or areas of discomfort with the study administrator. I understand that I can leave at any time. Please check one of the following: □ YES, I have read the above statement and agree to be a participant. □ NO, I choose not to participate in this study. Signature: _________________________________ Date: _______________________
Only four tasks are presented here for illustration. EHRUT Usability Test Moderator's Guide Administrator _____________________
Data Logger _____________________
Date _________________ Time _____________________
Participant # _________
Location _____________________
Prior to testing
■ Confirm schedule with Participants ■ Ensure EHRUT lab environment is running properly ■ Ensure Consent forms are complete for all participants ■ Ensure lab and data recording equipment is running properly
Prior to each participant: ■ Reset application ■ Restore application to base state using script restoredb.bat ■ Start session recordings with GTM Recording
Prior to each task: ■ Reset application to starting point for next task
After each participant: ■ End session recordings with tool ■ Fill out all paper work and acknowledgement form.
After all testing ■ Scan all forms and shred originals ■ Back up all video and data files
Orientation (5 minutes) Thank you for participating in this study. Our session today will last 2 hours today. During that time you will take a look at an electronic health record system. I will ask you to complete a few tasks using this system and answer some questions. We are interested in how easy (or how difficult) this system is to use, what in it would be useful to you, and how we could improve it. You will be asked to complete these tasks on your own trying to do them as quickly as possible with the fewest possible errors or deviations. Do not do anything more than asked. If you get lost or have difficulty I cannot answer help you with anything to do with the system itself. Please save your detailed comments until the end of a task or the end of the session as a whole when we can discuss freely. I did not have any involvement in its creation, so please be honest with your opinions. The product you will be using today is describe the state of the application, i.e., production version, early prototype, etc. Some of the data may not make sense as it is placeholder data. We are recording the audio and screenshots of our session today. All of the information that you provide will be kept confidential and your name will not be associated with your comments at any time. Do you have any questions or concerns? Preliminary Questions (5 minutes) What is your job title / appointment? How long have you been working in this role? What are some of your main responsibilities? Tell me about your experience with electronic health records.
Preview: First Impressions (6 Minutes) This is the application you will be working with. Have you heard of it? Yes ___ No ___ If so, tell me what you know about it. Show test participant the EHRUT. Please don't click on anything just yet. What do you notice? What are you able to do here? Please be specific. Notes / Comments:
Task 1: Create an Order – Ed Wood (5 Minutes) Take the participant to the starting point for the task. - FNC The patient you are examining 5’ 10” 285 lbs. male needs a differential diagnosis of 034.0 Streptococcal Sore Throat and needs a 87880 rapid strep to confirm diagnosis. Enter Vitals, Dx and SP into the system Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, enter 5 feet 10 inches and 285 lbs 2. go to the DX tab and Enter the diagnosis 034.0 Streptococcal Sore Throat 3. Note Alert for Obesity and Hypertension in CDS slider 4. Still inside FNC, go to the SP tab 5. Enter procedure code 87880 Strep A Assay 6. Still inside FNC, click the Close button to close the note, save the note as incomplete 7. Click okay.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 2: Utilize an existing Clinical Decision Support Alert – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You run are in consultation with a patient and his parent who is 71 years old. You want to quickly see if there are any Clinical Support Alerts for the parent. Go to the Appointment to review CDS Alerts and look at the source information for the alert. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
Open Patient Norman Wood
Open Update Appointment from Envelope
Open Clinical Decision Support Tab
Note Fall Risk Rule on Slider
Click on the Hyperlink for Fall Risk Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 3: Creation of a Procedure Task Message to the Nurses - Ed Wood (5 Minutes) Take the participant to the starting point for the task. - FNC
A patient you saw earlier that requested an order for a test at a different lab wants the lab found it was not covered by his insurance. He wants it to be performed in your office. You need to order a rapid strep test (87880) for the patient, as he is on his way back into the office.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open the scheduler 2. Find the appointment for Ed Wood 3. Click the Blue Folder (Open/Create note) 4. Click New->Procedure Task Message
a. Enter the Nurses b. Click Okay
5. Click to close the note a. Click Okay
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 4: Approve a Lab result (5 Minutes) Take the participant to the starting point for the task. - DESKTOP
You have a lab result request message in your inbox to process. You need to review and approve the request.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations Approval of Lab Results
1. Locate the Lab Result Approval message in the Desktop Message pane 2. Click on the Time and Date Hyperlink or Plus (+) sign next to the message 3. Click on Process Message 4. From the Modify Message window 5. After review of the results, click the Approved All button
a. Your user (provider) name will auto populate along with the current date 6. Click Complete
a. This will simultaneously set the approved lab results and complete the message Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 5: Document Drug Allergy in History – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are examining reports to you that she has been taking no meds because she has an anaphylactic reaction to Penicillins. Please document the allergy in History Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Find Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Click Drug Allergy
6. In the Allergen column, select Penicillins.
7. In the Reaction column, select anaphylaxis.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 6: Drug Allergy Alert in Rx Interaction – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP Need to prescribe Keflex to Mary Woods chart 1 tablet per day by mouth for 10 days Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Click Rx Tab
6. In the Drug field, enter Keflex
7. Click the find control
8. Select Keflex 500 mg
9. Pop up: Receive Drug Screening Warning: ALLERGY ALERT: The use of Keflex cross-sensitivity reaction based on a reported history of allergy to PENICILLINS. Do you want to continue? Click Yes
Comments: Observed Errors and Verbalizations: Comments: Rating: Overall, this task was: ___________ Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 7: Drug Drug Interaction – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP An agitated patient wants you to prescribe Prozac immediately. 20mg 1 time per day by mouth. Please prescribe the medication. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Find Mary Wood that has an appointment scheduled.
2. Click the Open/Create Note icon
3. FNC
4. Click Rx Tab
5. In the Drug field, enter Prozac
6. Click the find control
7. Select Prozac 20mg tablet
8. Pop up: Receive Drug Screening Warning: Duplicate Therapy: The use of Prozac is a duplicate therapy with Zoloft 50 mg. Do you want to continue?
a. Click No
9. Print -> Save and print Button
a. Print Dialog
10. Click ok to save and exit the note
Comments: Observed Errors and Verbalizations: Comments: Rating: Overall, this task was: ___________ Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 8: Medication List in OPS – Mary Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You are about to walk into an exam room for a med check on a patient. Go to One Page Summary and review the patient’s drug list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Go to Patient Demographics 2. Click Patient 3. Click One Page Summary 4. Click hyperlink in index for Current Medication 5. Verify the data is displayed correctly
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 9: Medication List in Hx Tab with Filter – Mary Wood (5 Minutes)
Take the participant to the starting point for the task. - DESKTOP
Previously very ill patient with a very large medication history is asking about her current medications. You want to compare the active/inactive medications with the maintenance medication list (which are two different filters in the system Go to Hx Tab and change the filter to show only Active Medications and them maintenance medications.
Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Inside FNC, go to the HX tab 2. Click on the Medication History 3. Review the items on the list 4. Click the search icon to change the filter 5. Change the filter to maintenance 6. Review the Maintenance Medications
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 10: Rx Refill Complete (5 Minutes) Take the participant to the starting point for the task. - DESKTOP You have a few minutes to complete your drug refill request messages Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Messages
2. Locate message
3. Click on patient’s blue envelope.
4. Select Process Rx Refill
5. Medication History screen
6. Select the drug by clicking the Refill button.
7. Sig Writer screen
a. Verify information in sig
8. Click Ok
a. Return to the Modify Message screen
9. Click Complete.
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 11: import Allergies from external list - Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are seeing has a C-CDA that needs to be checked against your record. Start with reconciling the Allergy list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open attachments 2. Go to attachments – Allergies - CCD 3. Click the import allergies icon 4. Sulfasalazine -> Add 5. Penicillin V -> Merge/Add 6. Carbamazepine -> ignore/remove 7. Click Reconcile 8. Go to Hx
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 12: Import Medications from external list – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP The patient you are seeing has a C-CDA that needs to be checked against your record. Start with reconciling the Medication list. Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Open attachments 2. View the medication CCD 3. Click the import medications icon 4. Simvastatin -> Add 5. Lorazepam -> Add 6. Lisinopril -> Add/Merge 7. Click reconcile 8. Go to patient Hx – Medications
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Task 13: Verify import in Allergy list and Medication List – Norman Wood (5 Minutes) Take the participant to the starting point for the task. - DESKTOP Please validate that the import of Allergy list and Medication list import has the expected information Success: (Yes / No) □ Easily completed □ Completed with difficulty or help □ Not completed Comments: Task Time: _____________ Seconds Optimal Path: □ Correct □ Minor Deviations / Cycles □ Major Deviations
1. Start at PRM desktop calendar
2. Find Mary Wood that has an appointment scheduled.
3. Click the Open/Create Note icon
4. FNC
5. Note the CDS rule for the combination of the new allergy and medication
6. Click Drug Allergy
a. Verify the information is correct from the import
7. Click on the Medication History
a. Verify the information is correct from the import
Comments: Observed Errors and Verbalizations: Comments: Rating:
Overall, this task was: ___________
Show participant written scale: "Very Easy " (1) to "Very Difficult" (5) Administrator / Note taker Comments:
Final Questions (10 Minutes) What was your overall impression of this system? What aspects of the system did you like most? What aspects of the system did you like least? Were there any features that you were surprised to see? What features did you expect to encounter but did not see? That is, is there anything that is missing in this application? Compare this system to other systems you have used. Would you recommend this system to your colleagues? Administer the SUS
Appendix 6: INCENTIVE RECEIPT AND ACKNOWLEDGMENT FORM
Acknowledgement of Receipt I hereby acknowledge receipt of $ _____ for my participation in a research study run by Aprima Medical Software. Printed Name: _____________________________________________________________ Address: __________________________________________________________________ __________________________________________________________________________ Signature: _______________________________________________ Date: ____________ Usability Researcher: ________________________________________________________ Signature of Usability Researcher: ____________________________ Date: ______________ Witness: ___________________________________________________________________ Witness Signature: ________________________________________ Date: ______________
Preamble Aprima Medical Software, Inc. is dedicated to easing the transition for physicians moving from either a paper-based environment, or another electronic health record (EHR), to one where information technology makes it easier to practice medicine and run the business of a practice. Since 1998, Aprima has helped thousands of doctors improve quality of care, patient satisfaction, the bottom line, and their own quality of life.
Our EHR, Practice Management, and Revenue Cycle Management solutions are designed to complement and simplify practice workflow. We serve physicians nationwide, in primary care and more than 30 specialties, from solo practitioners to large, multi-site clinics. Clients benefit from our vast experience in healthcare IT, the long-term vision of our leadership, our advanced technology that physicians use to optimize their practice, and our U.S.-based client support.
The 2015 version of the Aprima Patient Relationship Manager (Aprima PRM) system was developed based on over 20 years of experience with software applications for ambulatory clinics. The system was developed together with clinical specialists, software engineering experts, and IT professionals.
Definition and Standards
Definitions
Usability of software is defined as the ease of use and learnability. Usability includes methods for analyzing user needs and the benchmarking of “state of the art” health IT applications.
International Standards
Aprima PRM was developed using some concepts and practices from international guidelines and standards (ISO), but Aprima has chosen to implement other best practices not yet codified in international standards. In general, Aprima is transitioning from a waterfall software development methodology to an agile development methodology. Some aspects of each development methodology have had an impact on the Aprima PRM product.
History of the Software Development The software development of Aprima PRM 2015 is based on a long history of software engineering in the area of health IT. Aprima Medical Software, previously iMedica, started developing health IT software in 1998.
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Previous Generations
The first PRM generation was developed by the iMedica company. In 2011, the Aprima PRM application was developed following guidelines for usability of health IT applications. In 2013, the relevant components have been redesigned according to the ONC Meaningful Use requirements.
Existing User Base
The existing Aprima users play an important role in the improvement and update processes of the Aprima PRM software. The Aprima product team holds regular user feedback sessions via web session meetings and in-person workshops at Aprima User Conferences to gather critical user input into the enhancement, modification, and quality improvements for the Aprima PRM product. The results of these sessions and review processes have been factored into the customization and redesign processes of the Aprima PRM system.
Even the most brilliant physician can’t go it alone, and neither can we. Aprima and its staff are members of the following organizations that help us stay fully abreast of all the latest healthcare-related developments and news, from market trends to technological breakthroughs to regulatory requirements:
• American Academy of Family Physicians
• MGMA
• CHIT
• HIMS Electronic Health Record Association
• HIMSS
• Software advice
• Physicians Alliance Inc.
• Professional Association of Healthcare Office Management
Aprima is also very responsive to new government regulations and standards for electronic health record (EHR) systems. Aprima also participates in a number of quality and safety organizations to ensure that Aprima PRM meets the highest standard of quality, performance, and usability.
Definition of User Groups and Qualifications The Aprima PRM system is typically used by these specific user groups:
• Physicians and other providers of ambulatory medical services (clinical user groups)
• Ambulatory clinic support personnel
• Administrators and members of the practice management
• Revenue cycle managers and billers
Clinical User Groups
The clinical user groups typically include physicians, nurses, medical assistants, and lab specialists. They use the system when patients are with them in an exam or treatment area. The clinical user groups typically enter all medical data, such as medical history, general exam, vital signs, HPI, and chief complaint. These users follow clinical pathways which they can implement together with the Aprima product specialists within the customization process.
Non-Clinical User Groups
All other team members in an ambulatory clinical environment who are not defined as clinical users are classified as non-clinical users. They enter billing codes, generate reports and letters, run analyses, manage patient flow through the practice, schedule appointments, and perform any other administrative tasks in the practice. These personnel are typically members of the ambulatory clinic support personnel, administrators, and members of the practice management team and/or an outsourced revenue cycle management team.
Definition of User-Centered Development Process Aprima has incorporated a unique user-centered design process that includes an iterative approach to development. Although the full process is comprised of internal processes adapted from a long history of successful design. This process applies to each of the EHR Certification criteria below:
• §170.314(a)(1) Computerized provider order entry
• §170.314(b)(4) Clinical information reconciliation
Aprima’s design is based upon an understanding of users and their tasks and environments. We involve our users throughout an iterative design and development process to ensure that the design is driven and refined by user-centered evaluation. Our design team includes multidisciplinary skills and perspectives to ensure that our design addresses the whole user experience.
The design for new functionality, which includes any new feature or enhancement to existing features, is based on user enhancement requests. User enhancement requests entered into Salesforce Ideas are voted on by other users, which determines a ranking of requests by the user population as a whole. Product management reviews of these requests and their rankings to incorporate the enhancements into the product design. Enhancement requests from direct user contact and other user input are also reviewed for incorporation..
The definitions of users groups and their characteristics are included in the projects defined for development. Also included is knowledge of the user environments in which the functionality will be used (i.e. Mobile, Remote, Thick Client).
User involvement in the design and development includes a number of web-sharing meetings to discuss and review future and current product design. Aprima incorporate the feedback from the schedule conferences by capturing the requests/feedback as work items to be added to the product backlog for evaluation. Meeting notes and feedback are documented and provided to all participants, and screenshots are captured and mocked. These meetings include:
• Weekly Doctor Advisory Design Meeting
• Monthly Physician/Customer Design Meeting
• Weekly Revenue Cycle Management Design Meeting
• Monthly Practice Management Design Meeting
• Internal Brown-Bag meetings
• Quarterly Management Roadmap Review
• Yearly User Conference
Other sources of user input may include, but is not limited to, the following:
• Aprima Sales and Marketing provide feedback from customer demonstrations on features and functions they would like to see.
• Requests for proposals contain detailed lists of functionality requested by perspective customers.
• Product Analysts review various federal and state regulations to determine additional functionality.
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From this input, the design team prioritizes and ranks identified work items to determine the high priority items that most effect the design. User priorities are identified in Salesforce Ideas, and then reviewed and evaluated by the product owners. Once work items are identified from these priorities, then work items are created in Team Foundation Services, where they are ranked and tracked. Work items are then addressed based on priority, resource availability, and impact/risk on current design.
Each update to the product is developed with an iterative process. The key steps within each version are:
• Define the users, context, and expected tasks
• Develop prototypes (storyboards and drawings)
• Incorporate feedback from stakeholders and users
• Develop functionality
• Review and incorporate feedback
• Release user testing (release candidate) product version to limited user group
• Incorporate feedback from the release candidate users
• Release the General Release product version
The develop process for any project must keep in mind general user concerns. This includes such things as typical use of the system is eight or more hours a day, that users are concerned about the number of clicks needed to complete any task, and that users need to be able to complete tasks as quickly and efficiently as possible.
The design team for all development projects is cross-functional. Design teams include members from Support, Training, Sales, Marketing, Quality Assurance, Engineering, and customers (including Doctor Advisors), as needed for each specific project. Team members provide input throughout the process on both the product and related materials.
Product design includes user documentation and training to ensure that users are aware of and educated on product functionality.
Definition of User Requirements The user requirements depend on the tasks the user groups have to perform within the software. Therefore, the development of the user interface and the test processes generally address these user design concepts.
Easy to Implement, Train, and Support
The introduction of a PRM system means significant change for the entire clinical and non-clinical team. The easy to implement, train, and support requirements allow the Aprima PRM system to be installed and used by all of the clinic’s personnel in a short amount of time. The
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involvement of our user base in designing the product facilitates the rapid deployment of the system within clinical settings.
Any PM/EHR system is a substantial investment by the practice, and to become productive with it is an important goal of the development process.
Improve the Practice’s Overall Practice Efficiency
Aprima’s goal is to save the practice time, improve their patient care, and get them paid promptly. Our goal is to make the overall practice more efficient. This efficiency also meets the new Meaningful Use standards.
The following components are identified for an efficient and easy to use system:
• Clinical pathways with structured exam templates dedicated to the encounter type of the patient
• Intelligent pick lists which represent the most common data codes and descriptions for the corresponding chart area
• Chart monitor functionality which reminds the user to enter important data which has been forgotten
The Aprima PRM system is highly configurable and customizable. It is easy to configure for almost any type of practice environment ranging from home-health to typical ambulatory care practices.
The user experience in any of these environments guides the development of new functionality, product improvements, and third-party product adoption.
User Context and Environment A great deal of attention is paid to the user experience. Reducing the number of clicks, speeding the capture of data through automation, and improving the patient experience are all goals of the Aprima PRM.
Interaction with Patients
The Aprima PRM takes into account the patient experience as related to Aprima by the clinics themselves. This ranges from weekly physician calls, to user group meetings, to the Aprima release candidate (RC) program. Aprima has developed a patient portal to ensure the patient has access to their data in real time. In addition, this gives the provider an ideal means to communicate securely direct with their patients.
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Data Collection
The Aprima PRM system supports a large number of ever increasing third-party devices and interfaces. There are over 8,000 different interfaces to the Aprima PRM including all of the major labs, many medical devices, and third-party clinical registries.
All of these interfaces reduce the amount of data entry the clinicians have to perform while increasing the overall quality of the data.
Aprima’s customers have often referred device manufacturers as well as other interface prospects to Aprima. Aprima has turned a number of these into direct released products.
Aprima is also compliant with the numerous Meaningful Use requirements for data collection. These include the secure messaging and medical record exchange standards.
Aprima also provides a mobile application which supports many of the functions of the desktop system. Clinicians are a very mobile customer base, and their feedback into the features required of a mobile app have been a key part of the developmental process.
Data Management
The Aprima PRM has to be able to report consistently clinical and financial information. The system provides a multitude of reports to meet these needs. Customer input was a key part of developing these reports.
The Aprima PRM also provides numerous security models to these reports and other functionality within the system. The enables the customer to manage what data is used and by whom.
As mentioned before, Aprima supports numerous government standards for reporting and data exchange. Our users provide critical feedback into how data is managed.
Consistency and Usability The visual display, colors, and the dialogs for filling templates and forms have a high priority. Aprima PRM 2015 was developed strictly according to the principals of the ISO standard.
Global Screen Layout
The global screen layout is based on the experience with previous EHR generations and corresponding with user tests for data entry efficiency and data display quality. Aprima PRM ships a default color and screen layout, but through the configurability options, custom forms and reports and dynamic procedure note technology, Aprima offers many options for the customer.
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There are many pick lists in the Aprima PRM product implemented through a “find control”. These lists make is much easier for the user to choose the appropriate information and speed the data entry process. These pick lists were defined through numerous customer interactions, especially with our physicians review board.
Templates and Fonts
The templates have been designed for standard screen resolution of 1280 x 800 minimum. This combination allows a template design with easy to use buttons for touch screens and mouse clicks.
Color Schemes
Aprima PRM permits custom selection of color schemes. This permits compliance with ISO standards as well as user preferences. Many aspects of Aprima PRM permit the choice of colors ranging from the appointment schedule to the GUI experience.
Quality Management The entire processes of system analysis, development, testing, and documentation follow well known industry quality management principles including regression, performance, and automated testing.
System Analysis
Development uses several methods for system analysis. The primary mechanism today is the use of gap analysis and scenario development. During the customer feedback sessions, product quality gaps are identified and scenarios/quality assurance tests are generated to reproduce the problem. Development then addresses the issue, and the tests are rerun to verify the problem has been addressed.
This process is documented using Microsoft’s TFS system. Error test cases are automatically generated from scenarios and bugs.
Development
Engineering is transitioning from a waterfall methodology to the widely accepted agile methodologies. A number of engineering development efforts now use scenarios and sprints to build new functionality and address defects in existing product releases.
All of these scenarios are documented (functional definitions) in the Microsoft’s TFS system. Engineering status’ of percentage complete is then tracked by the development team lead (SCRUM Master), the QA manager, Release Manager and Engineering senior management.
Ref: 8022.02 13
Releases are tied to a particular set of sprints. These sprints define what changes have been implemented. This change management is reported through TFS analysis reports.
Testing
Aprima Quality Assurance (QA) team creates test plans for each sprint from development. Test suites are created along with test cases for each suite from a provided product backlog user story. Daily results are provided for hotfixes, patches, and major releases.
Work items created from the user base are controlled through QA to ensure that the user’s workflows are being tested as the user workflow. These workflows are transformed into additional test cases for manual/regression testing.
The manual team uses a test management software to track, create, and test all new product backlog items. When a manual team member deems a test case necessary for automation, the test case is marked to be included in the automation testing.
The automation team uses an automation testing software to create and run scripts for automation testing. These scripts run against a daily build of the Aprima PRM software to monitor any changes in the code.
Prior to any release, QA presents to the release management team all testing results, known issues, and outstanding work items.
Regression Testing
Regression testing runs on a daily basis. Both the manual and automation teams run test cases on a daily basis. All results are published to engineering.
Performance Testing
Performance testing occurs in automation testing on a daily basis. On-demand performance testing is accomplished for each hotfix prior to release.
Manual and Automation Testing
• The Aprima QA manual team creates test suites and test cases for each iteration/sprint from development’s backlog to record test steps and results. All bug fixes are tested by the manual team.
• The Aprima QA automation team creates automation scripts using an automation testing software. These scripts are ran against a daily build of our code to verify any changes that may occur.
• All test results for hotfixes, patches and major releases are presented daily and prior to giving to release management.
14 Ref: 8022.02
User Acceptance Testing
User acceptance testing is completed by Aprima, and the results are documented using the NISTIR-7742 template.
Documentation and Training
The Aprima system provides a large number of documents, online help screens, various training videos, webinars, and hands on on-on-one training.
Online Help
The online help includes conceptual information for the various functions, window-specific information, and workflow information for common business tasks.
Users can access the online help by selecting Help → Contents, or by pressing the F1 key. Accessing the help through the menu opens the help file to the splash window with the help table of contents displayed. Pressing F1 opens the help file to the window-specific information for the active window.
Updates and corrections to the online help are pushed to customer database monthly.
User’s Guides and Other Documents
The basic user’s guide set covers the functionality of the entire application, and the tasks that various user roles perform with the application. The user’s guide set includes:
• Administrative User’s Guide
• EHR User’s Guide
• Practice Management User’s Guide
• General User’s Guide
• Reports Guide
In addition to the comprehensive user’s guide set, Aprima also maintains installation and upgrade guides, various technical documents, and quick guides for specific features (such as Direct messaging) and purposes (such as Meaningful Use). Support alerts and weekly product updates are used to distribute timely information to users.
All user’s guides and other documents are available to clients through the Aprima Customer Portal.
Ref: 8022.02 15
Training
Training is offered in a variety of formats. Hosted web-session and quick reference video training is available through the Aprima Academy on the Aprima.com website.
• Pre-Implementation Training: Prior to implementing Aprima PRM for a new customer, the customer's users are able to attend a number of web-base training sessions. All users are encouraged to attend, and may attend any of these sessions as often as they like. On-site, in-person training is conducted immediately before or during the implementation of the application.
• Hosted Web Sessions: Free hosted web-based training sessions are offered on a routine basis, and cover specific topics or areas of the application, including Meaningful Use, CQM, and product features required to meet the various measures.
• Upgrade Training: Free hosted web-based training sessions are offered to customers who upgrade to a new version of Aprima PRM. The upgrade training is specifically designed to cover product changes and enhancements.
• Quick-Reference Videos: The quick reference videos cover many topics for different types of users. There are videos on the different versions of the Aprima PRM, Meaningful Use, and support tips.
• Private Web Session and On-Site Training: Customers may request and purchase private web sessions and on-site training to review any topics that they desire.
Customization Potential and Processes In the health care market, customization of the user experience is essential. While Aprima has adopted certain standards for the product, there are many options to customer and tailor the product to the practice, provider group, and individual user.
It is often said of the Aprima PRM that there is more than one way to accomplish any task. The product is very flexible in response to the diverse customer needs of the medical community.
General Adaptation to User Specialties
APRIMA PRM offers specialty and subspecialty templates and enhancements. This makes the product useable by the majority of practice specialties and institutions. Aprima PRM also offers many features which are specific to a particular specialty, such as home care.
The areas of customization include:
• Codes and terminologies
• Clinical pathways with specialized dynamic procedure notes
• Clinical decision support systems
• Pick lists with frequently used documentation components
16 Ref: 8022.02
• Reviews and reports
Language and Terminologies
The system can be adapted to the local clinical language and terminology. The user can chose from SNOMED compatible codes and descriptions and modify the descriptions according to the user context.
Aprima also supports multi-lingual patient management. Multi language patient education and information documents are supported.
Clinical Pathways
Clinical pathways are essential for the realization of “evidence based medicine” which support the clinical decision process. The user can define and preset exam and therapy routines following clinical guidelines. The customized exam forms support the usability of the system according to well know AMA protocols.
Workflow Management
In addition to the clinical pathways, the users can manage the organizational workflows within the Aprima PRM. Using the messaging capabilities in the system, the users in the clinic can coordinate all relevant tasks such as:
• Practice billing and collections
• Scheduling and appointment management
• Patient management
• Prescription management
• Physician order management
• Patient education
• Support of the patient portal
Test Management Aprima runs a set of rigorous test in our Quality Assurance organization. The QA team develops tests based upon engineering specifications or scenarios. Many of these tests are automated and run as regressions test for each release.
Other tests which cannot be automated are performed by QA team members for each hotfix, patch, and major release of the system.
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Post-Market Tests
Aprima runs a release candidate (RC) program for every minor and major release. This program engages real physician practices in using the newest Aprima PRM product prior to general release. The feedback from these RC programs provide invaluable feedback to engineering for the correction to defects, the enhancement of the product, and the development of new workflows.
Aprima utilizes two substantial feedback systems: Salesforce.com customer management software and Microsoft’s TFS to manage and correct bugs. These systems are routinely analyzed for defect status, bug resolution statistics, and root cause analysis.
Conclusion The usability of the Aprima PRM 2015 version is based on standardized system analysis, development, test and improvement processes, some of which align with International Standards (ISO), but some of which are new and innovative development methods and practices. Aprima strives to adopt industry best practices while pursuing unique and important innovations.
The feedback loops for the Aprima PRM a numerous; beginning with the definition and design phases, through the RC program, and ultimately in the product release customer bug reporting and feedback process.
The Aprima PRM development team is always striving to improve the product functionality and quality. User Centered Design is a key component of these goals.
Test Results Summary for 2014 Edition EHR Certification17-2999-R-0009-PRA V1.0, March 6, 2017
